Intrepid valve
From Bay Area Structural Heart Wiki
Note: CALL MILENA AS SOON AS PATIENT IS IN THE ROOM!! 415-368-3094
File:Intrepid supply list.pdf
Setup Notes
- Reps prep - ~ 1 hour!
- 6 liters cold saline
- Pressure bags x2 for device drips
- Open 1 extra pickups (suture removal kit)
- Mitra-clip plate and stool provided by reps
- Use Coban to attach long table to short table end-to-end to make extra long table(drape first).
- Surgical access
- Neptune and Bovie
- OR setup like carotid
- Cut-down with plegeted purse-string
- A/V access on opposite side
- Monopolar pacing in LV via arterial access with Safari and apical pacing patch
- Stool edge is 100cm from mid-sternum
Open
- TAVR pack
- Back table cover
- 6fr. Pinnacle
- 8fr. Pinnacle
- Micropuncture
- 0.035x150 J-wire
- 5fr. JR4 diagnostic catheter
- Lunderquist J-wire 260cm
- Watchdog (10/6/22 DD tested RV pacing, may not need don't drop)
- Alligator clip pacing cable (Black clip stays on table; pass off red and plug to circ.)
- Perclose
- 2 Roto-tubing(for back table)
- 2 60ml syringes (for back table)
- 2 20ml syringes (for back table)
- Acist setup with 100% contrast for RV or LV gram
Procedure
- Surgical cutdown to RFV
- LFA access with micropuncture -> 6fr. Sheath
- 18 gauge entry needle access -> 8fr. Sheath to RFV
- Maybe Pigtail advanced for RV-gram (Reference image. Lunderquist advanced thru pigtail if used.)
- 150 J loaded in JR4 inserted
- J-wire removed for Lunderquist
- Intrepid sheath inserted over Lunderquist
- Manipulate valve to pre-deployment position
- 150J loaded in JR4 -> LFA to cross Aortic valve
- J-wire out for Safari
- Safari positioned in LV and alligator clip attached (black to back)
- Pacing threshold tested
- Final positioning of valve and deployed while pacing.
- Safari and JR4 removed
- Intrepid sheath removed and surgically closed
- Perclose to LFA
