Watchman

Watchman - Left Atrial appendage closure
Anesthesia	Imaging	Access	ACIST/manifold
General	Fluoro and TEE	14F RFV	One manifold with contrast
Pre-Procedure Watchouts
PRE PROCEDURE: Type and Screen

Type and Screen

Open

• Micropuncture
• 8fr sheath (dilator used pre-Perclose)
• Probe cover
• 1 Perclose
  • 0-Prolene or 0-PDS (Spies will add a suture after perclose if site is oozing. If no ooze Exofin.)

• Cordis 150J

• 5fr Straight Pigtail
• 3-port manifold
• Baylis VersaCross Access System (purple box in structural cart)
• Grounding pad
• (Spies - Lido with EPI)

Standby

• 4 or 5fr Pinnacle for Arterial line

• 190 Supracore
• Wholey / Versacore

Watchman supplies:

• 14fr Watchman access sheath (Open as requested after TEE)
• Watchman device (Size as requested after TEE)

PROCEDURE

1. Basic table set up ONLY until it is determined by TEE that case will proceed.
2. TEE performed. Procedure aborted if clot
3. Prep bilateral groins and drape once probe has been inserted.
4. Micropuncture ultrasound-guided RFV access
5. 5 Fr Micropuncture sheath
6. Baby J wire from sheath
7. 8 Fr dilator
8. 6 Fr Perclose pre-close RFV. .032 wire inserted after preclosure deployment.
9. .035 J wire from versacross system advanced thru perclose for Baylis sheath advancement.
10. .035 J wire removed, VersaCross RF pigtail wire advanced for transeptal puncture.
11. TEE & fluoro guided transeptal access & images of Left Atrial Appendage
12. Anesthesia gives Heparin IV. ACT GOAL >250-300
13. Transeptal puncture, ACT drawn from LA.
14. Measure LA pressure
15. 15 Fr WATCHMAN delivery sheath either SINGLE, DOUBLE or ANTERIOR Curve
16. Backloaded 5 Fr Str Pigtail advanced to the LAA
17. Hook pigtail up to manifold for angiogram of LAA
18. Measure and select size of Watchman device
19. Open and prep Watchman Device -
    • Open touhy
    • Exercise delivery
    • Advance feet of device to just inside of marker
    • Leave touhy open and attach to manifold with pressurized hep saline open, close touhy and flush to device. Tap through delivery system while flushing. (Size: 21, 24, 27, 30, 33mm)
20. Pigtail removed just prior to delivery system insertion.
21. Insert delivery with a wet-to-wet connection (leaving pressurized saline on)
22. Once inserted, begin filling delivery system with contrast. Delivery system takes 20ml to fill.
23. Deploy Device. Confirm placement to meet PASS criteria: Position Anchor, Size, Seal. Can be recaptured/reposition. Fully unscrew to deploy device.
24. Placement confirmed by LA angiogram
25. Delivery system removed as MD tamps perclose knot.
26. If access is clean, Dermabond. If bleeding, woggle.

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APPROVED: MD initials MM/YY