TTVR

Sheaths:[edit | edit source]

• 5Fr Micropuncture  Kit  
• 8Fr x 10 cm sheath (Dilator used only)

Wires[edit | edit source]

• (1) Cordis 150J
• 1 cm Amplatz Extra Stiff 260cm

Catheters:[edit | edit source]

• 6Fr Ang Pigtail

Medications on table:[edit | edit source]

• Lido/Bupivicaine 50/50

• Epinephrine 10mcg/ml in red medallion syringe (From anesthesia)
• 10 ml Rotaglide

Miscellaneous Supplies[edit | edit source]

• (4) Sterile Bowls
• Back table cover
• High Pressure stopcock
• 60ml syringe
• 20 ml syringe
• (1) Perclose
• Fluoro cover
• (3) hemostats

Transvenous pacemaker supplies[edit | edit source]

• Medtronic alligator pacing cables
• MYO/WIRE Temporary Cardiac Pacing Wire (Suture)

Standby ECMO & Pericardial Effusion supplies[edit | edit source]

Procedure[edit | edit source]

Patient on defib pads. IF PATIENT HAS ICD: DEVICE DISABLED FOR PROCEDURE, COMPANY REP PRESENT IF POSSIBLE. IF PATIENT HAS A PPM/ICD RAPID PACING WILL BE PERFORMED VIA PROGRAMER.

Leg strap secured above knees. Wrists restrained.

Patient prepped from naval to mid thigh using chlorhexidine soap followed by chloraprep with 3 minute dry time.

Towel off site. Extend Femoral drape all the way to chin.

Fluoro cover used to drape anesthesia's IV pole/x-ray shield.

No venous or arterial lines for anestesia.

Ultrasound guided access for Dr.Spies only.

FRONT TABLE

50/50 Lido and Bupivacaine mix used for local anesthetic. Have extra available on front table.

10ml of Rotaglide on table (for E sheath just prior to valve insertion)

10ml syringe of 10mcg/ml of Epinephrine taped on table.

BACK TABLE- valve prep

4 Bowls: (2) Normal Saline (1) Hep Saline (1) 30ml contrast, 170ml Hep Saline mix (15%)

60ml Syringe with contrast mixture for balloon prep

20ml Syringe for flushing delivery system

Indelator: volume dependent upon valve size

Crimper

Hemostats and scissors for valve opening

PROCEDURE STEPS

• RFV access obtained with cook needle. Verify wire position with fluoro and save an image.
• Dilate with 8F dilator than pre-close with perclose device. Perclose suture secured with hemostat.
• After perclose Esheath is advanced with .035 exchange J wire.
• Pigtail advanced to cross tricuspid valve. Once pigtail is in RV the .035 exchange J wire is exchanged for the Amplatz ES wire.
• Pigtail is removed.

• Pacing will be performed via pacing suture and alligator clip cables if patient doesn't have an existing PPM.
• Rotoglide in sheath as delivery system advanced.
• Insert valve delivery system
• Pace -> Deploy valve
  • Cine length set at 40 seconds or more
• TTE

if post dilation is needed...

Rep will come up and re-prep valve, adding desired amount of additional volume

If Amplatz ES was pulled back, recross wire will be needed (260cm straight stiff glide)

• Pigtail readvanced to AO for AO gram (15/30 standard injection)
• Amplatz ES exchanged for 260 J
• Delivery system removed
  • Have perclose tools and dilator ready
• Protamine given, Preclosure completed, manual pressure for 5ish minutes

EMERGENT PERICARDIOCENTESIS[edit | edit source]

Call Echo

Supplies:[edit source]

Emergency Kit located in each lab containing the following items:

• Eye drape
• Chiba biopsy needle 10cm 18g
• Skater introducer set
• Bard locking pigtail (6f or 8f)
• (3) 60ml luer lock syringe
• Standard .035 150cm j wire
• Amplatz super stiff .035 180cm wire
• Probe cover
• Stopcock
• Accordion drainage bag