Valve in MAC with Antegrade Lampoon: Difference between revisions

From Bay Area Structural Heart Wiki
(not finished)
(final update from case 12/10)
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#Medtronic Core Valve – all items are charge separately.  Scan all barcodes (delivery system, loading system and valve).
#Medtronic Core Valve – all items are charge separately.  Scan all barcodes (delivery system, loading system and valve).


MITRAL CLIP (Mitral/Tricuspid):


#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:===
===Access sites:===
26F RFV
26F RFV
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'''EXTRANEOUS SUPPLIES'''
'''MISC SUPPLIES'''


(2) Watchdog devices
(2) Watchdog devices
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Safari  
Safari  


Amplatz SS 1cm
Amplatz SS 1cm  


8F Sheath  
8F Sheath  
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Obtain access as listed above.
Obtain access as listed above.


Preclose RFV x 2
Preclose LFA x 1 and 8F sheath inserted
 
Dryseal inserted


Preclose LFA
Preclose RFV x 2 and dryseal inserted


SL1- transeptal puncture
SL1- transeptal puncture
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Agilis x 2 inserted
Agilis x 2 inserted


6F PA floated through one of the Agilis and glidewire inserted
6F PA floated through one of the Agilis over glidewire
 
PA catheter exchanged over glidewire for 6F JL3.5


Runthrough in 6F JR4 and snared through 7F in LV
Glidewire exchanged for Runthrough


7F JR4 with ensnare to LFA
7F JR4 with ensnare inserted through LFA. Runthrough snared in LV.


6F JR4 through one of the agilis.
PA catheter removed and 6F JL3.5 advanced over snared runthrough


Runthrough in 6F JR4 and snared through 7F in LV
6F JR4 through other agilis.


6F JR4 removed and reinserted over .032 wire---- or '''6FMP'''??
Lampoon equipment advanced through 6F JR4


Lampoon equipment advanced through 6F JR4/MP
25mm snare through JL3.5 next to runthrough
 
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.
Anterior leaflet traversed.-- Test bovie at 30 cut. Increase to 70 cut for traversal and laceration.
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Valve inserted and deployed.
Valve inserted and deployed.


Pigtail for wire removal
Pigtail for wire exchange
 
If a post deployment gradient is needed, balloon pump will be removed and short 8F sheath exchanged for 8F 90cm shuttle sheath. 125cm pigtail inserted to LV. 2nd manifold needed.




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<nowiki>*</nowiki>Possible ASD Closure
<nowiki>*</nowiki>Possible ASD Closure
<nowiki>*</nowiki>Flow monitor on left leg?


[[Category:Procedures]]
[[Category:Procedures]]

Revision as of 17:46, 15 December 2020

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).


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


MISC 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 LFA x 1 and 8F sheath inserted

Preclose RFV x 2 and dryseal inserted

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 over glidewire

Glidewire exchanged for Runthrough

7F JR4 with ensnare inserted through LFA. Runthrough snared in LV.

PA catheter removed and 6F JL3.5 advanced over snared runthrough

6F JR4 through other agilis.

Lampoon equipment advanced through 6F JR4

25mm snare through JL3.5 next to runthrough

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 exchange

If a post deployment gradient is needed, balloon pump will be removed and short 8F sheath exchanged for 8F 90cm shuttle sheath. 125cm pigtail inserted to LV. 2nd manifold needed.



*ECMO??

*Possible ASD Closure

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