Valve in MAC with Antegrade Lampoon

GENERAL ANESTHESIA AND TEE IMAGING, RADIAL ART LINE BY ANESTHESIA

BIPLANE IMAGING

OVERLAY FOR SENTINEL

PRE PROCEDURE: TYPE AND CROSS, ASPIRIN GIVEN

MAC- Mitral Annular Calcification

https://www.jtcvs.org/article/S0022-5223(18)31545-9/pdf

Per Rosalie:

TAVR/TMVI

1. Edwards Sapien 3 Ultra (20, 23 & 26mm) and Sapien 3 (29mm) – scan the valve barcode (box) in McKesson for documentation and charges.  Bundle includes valve, delivery system, crimper, e sheath intro set, balloon cath & locking syringe.  With the new inventory system (POU) space is limited in entering item full description.   If pre dilatation Edwards balloon is necessary free text the balloon used in procedure notes (McKesson).
2. Medtronic Core Valve – all items are charge separately.  Scan all barcodes (delivery system, loading system and valve).

MITRAL CLIP (Mitral/Tricuspid):

1. Use the barcode on Mckesson screen in Lab 1 – Mitraclip (Abbott) bundle consists of (1) Steerable Guide Catheter, (2) NTR Clip Delivery System & (1) XTR Clip Delivery System.

GENERAL ANESTHESIA AND TEE IMAGING, RADIAL ART LINE BY ANESTHESIA

ACCESS 2 FEMORAL VEINS (TAVR AND PACER)

PRE PROCEDURE: TYPE AND CROSS, ASPIRIN GIVEN

Access sites:

26F RFV

8F LFV

8F LFA

Open:

FROM STRUCTURAL HEART CART

.014 Astato xs 20 guidewire 180cm

Piggyback wire converter 4fr x 145

26F Dryseal

14mm Armada Balloon

SL1

Baylis Needle

Bovie pen

Grounding Pad

EXTRANEOUS SUPPLIES

(2) Watchdog devices

(2) Stopcocks

4 hemostats

(3) 60ml syringes

(2) 12 inch extension tubing

Bowl of D5

(2) Agilis SM Curl

Priority Pack

Balloon Pump

FROM STORE ROOM

8F 35cm Brite Tip Sheath

Josephson Pacing Wire

Remington Cable

Blue Pacing Cable

Sentinel- opened after grandslam wire across great vessels

FROM ROOM SUPPLIES

6F PA Catheter

260cm Angled Glidewire

(2) .032 260cm J wire

(1) .035 260cm J wire

(1) .035 150cm J wire

300cm Grandslam

300 cm Runthrough wire

Safari

Amplatz SS 1cm

8F Sheath

6F JR4 Guide

6F JL3.5 Guide

7F JR4 Guide

5F MPA1

6F Straight Pigtail

5/6 Slender Sheath

18/30 Ensnare

25mm Gooseneck snare

Preclose x 3

0 Ethibond

0 Prolene x 2

Standby:

12F Flexcath

6F MP Guide

8F 90cm Shuttle sheath and 125cm Pigtail for measuring gradient post valve placement

Rough Procedural Plan:

Obtain access as listed above.

Preclose RFV x 2

Dryseal inserted

Preclose LFA

SL1- transeptal puncture

Amplatz SS through SL1

Exchange SL1 for 6F JR4

Double .032 in JR4

Agilis x 2 inserted

6F PA floated through one of the Agilis and glidewire inserted

PA catheter exchanged over glidewire for 6F JL3.5

Runthrough in 6F JR4 and snared through 7F in LV

7F JR4 with ensnare to LFA

6F JR4 through one of the agilis.

Runthrough in 6F JR4 and snared through 7F in LV

6F JR4 removed and reinserted over .032 wire---- or 6FMP??

Lampoon equipment advanced through 6F JR4/MP

6FJL3.5 advanced over Runthrough

25mm snare through JL3.5

Anterior leaflet traversed.-- Test bovie at 30 cut. Increase to 70 cut for traversal and laceration.

After leaflet traversal and system snared- 7F guide and Runthrough removed.

Balloon pump inserted.

Pacer inserted.

Leaflet lacerated.

Lampoon system deconstructed.

Pigtail advanced with Safari

Pigtail out.

Septostomy

Valve inserted and deployed.

Pigtail for wire removal

*ECMO??

*Possible ASD Closure

*Flow monitor on left leg?