Carotid TAVI

Carotid TAVR
Anesthesia	Imaging	Access
General	Fluoro and TEE	Carotid cutdown Right Radial
Pre-Procedure Watchouts
Transcutaneous O2 Sat MAP above 100

Equipment

• Micropuncture (for Sheridan)
• 6F 10cm Pinnacle Sheath (for Sheridan)
• 5/6 Slender
• .035 x 150 J wire
• .035 x 260 J wire
• Straight stiff glide wire
• 5F AL1
• 5F Angled Pigtail
• Alligator pacing cable
• Safari wire - if using commander delivery system

• 180 Amplatz SS 4cm tip - if using certitude delivery system, in the TAVR cart

Setup- Right Sided Carotid

• Anesthesia to get left sided A line
• Table at 50 degrees
• Bring C arm in perpendicular to table
• Echo at head of bed (TEE)
• OR will do prep. (Include groins and right wrist)
• First assist to stand at head of bed on the left
• CT surgeon on right side with scrub RN
• Cath Lab will have standard 2 tables plus high table for valve delivery.
  • mayo stand to bridge the gap between valve table and access site
• Cover Fluoro Pedal and Base of C-arm
• 2 venous extensions needed for Anesthesia (if doing bi=polar pacing)
• Leave large boom to the side of the room. Use Monitors 3 &4 for pigtail and pacer.
  • 3 Live and 4 McKesson
• When DD moves to the head to assist with valve crossing bring in monitors 3 &4
  • 3- echo 4-Mckesson 1- Live 2- Anesthesia Vitals
  • Right wall monitor with quad view
  • boom with standard tavr display

Procedure- Right Sided

• Sheridan will start with cutdown.
• DD will obtain radial access for pigtail (and femoral venous for Pacer if using certitude delivery)
• AO gram per usual
• CTS inserts 6F sheath
• One CL tech stays at foot of bed for injections and pigtail pull
• Preloaded AL1 and Stiff glide inserted
• stiff glide exchanged for SAFARI
• E sheath inserted
• Valve delivered
• Venous sheath removed and figure 8 with prolene
• TR Band applied after OR finished closing.