Valve in MAC with Antegrade Lampoon: Difference between revisions

From Bay Area Structural Heart Wiki
(final update from case 12/10)
(step/equipment updates HW)
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'''GENERAL ANESTHESIA AND TEE IMAGING, RADIAL ART LINE BY ANESTHESIA'''
'''GENERAL ANESTHESIA AND TEE IMAGING, RADIAL ART LINE BY ANESTHESIA'''
'''BIPLANE IMAGING'''


'''OVERLAY FOR SENTINEL'''
'''OVERLAY FOR SENTINEL'''
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===Access sites:===
===Access sites:===
26F RFV
26F RFV (For transeptal equipment) (No need for E-Sheath)


8F LFV
8F LFV (For pacer)


8F LFA
8F LFA
<br />
(For IABP)
 
6F RFA (For JR4 Guide)
 
6F RRA (For Sentinel)


===Open:===
===Open:===
'''FROM STRUCTURAL HEART CART'''
'''FROM STRUCTURAL HEART CART'''


.014 Astato xs 20 guidewire 180cm
.014 Astato xs 20 guidewire 180cm for ALEGRA; 300cm for standard


Piggyback wire converter 4fr x 145
Piggyback wire converter 4fr x 145 (or finecross, confirm)


26F Dryseal
26F Dryseal
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'''MISC SUPPLIES'''
'''MISC SUPPLIES'''


(2) Watchdog devices
(3) Watchdog devices


(2) Stopcocks
(3) Stopcocks


4 hemostats
4 hemostats
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8F Sheath  
8F Sheath  


6F JR4 Guide
(2) 6F JR4 Guide


6F JL3.5 Guide
6F JL3.5 Guide
7F JR4 Guide


5F MPA1
5F MPA1
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5/6 Slender Sheath
5/6 Slender Sheath


18/30 Ensnare
25mm Gooseneck snare (Able to utilized this snare for both wire grasps)


25mm Gooseneck snare
Preclose x 4


Preclose x 3
0 Ethibond


0 Ethibond
0 Prolene


0 Prolene x 2<br />
TR-Band<br />


===Standby:===
===Standby:===
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Obtain access as listed above.
Obtain access as listed above.


Preclose LFA x 1 and 8F sheath inserted
After radial access Grandslam advanced to determine if Sentinal can be utilized. Grandslam removed until all access are obtain.


Preclose RFV x 2 and dryseal inserted
Preclose LFA x 1 and 8F sheath inserted for IABP


SL1- transeptal puncture
Preclose RFV x 2 and dryseal inserted over super stiff wire
 
6F Pigtail advanced for arch shot (20 for 20) for sentinel.
 
Grandslam and Sentinal advanced. Pigtail removed after sentinel in position.


Amplatz SS through SL1
Balloon pump advanced.


Exchange SL1 for 6F JR4
SL1- transeptal puncture


Double .032 in JR4
Exchange SL1 for two .032 wires


Agilis x 2 inserted
Agilis x 2 inserted


6F PA floated through one of the Agilis over glidewire
6F PA floated through one of the Agilis over runthrough
 
Glidewire exchanged for Runthrough


7F JR4 with ensnare inserted through LFA. Runthrough snared in LV.
6F JR4 with ensnare inserted through LFA. Runthrough snared in LV.


PA catheter removed and 6F JL3.5 advanced over snared runthrough
PA catheter removed and 6F JL3.5 advanced over snared runthrough
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Lampoon equipment advanced through 6F JR4
Lampoon equipment advanced through 6F JR4


25mm snare through JL3.5 next to runthrough
25mm Gooseneck snare through JL3.5 next to runthrough
 
(if ballooning leaflet for LVOT obstruction make sure "flying-V" isn't added to wire until after 5.0 x 20 compliant balloon is utilized)


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.


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


Pacer inserted.
Pacer inserted.
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Leaflet lacerated.
Leaflet lacerated.


Lampoon system deconstructed.
Lampoon system deconstructed. (May need SL1, 032 wire and agilis to regain transeptal access; so quickly reprep one agilis)


Pigtail advanced with Safari
Pigtail advanced with Safari

Revision as of 00:22, 26 March 2021

GENERAL ANESTHESIA AND TEE IMAGING, RADIAL ART LINE BY ANESTHESIA

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 (For transeptal equipment) (No need for E-Sheath)

8F LFV (For pacer)

8F LFA (For IABP)

6F RFA (For JR4 Guide)

6F RRA (For Sentinel)

Open:

FROM STRUCTURAL HEART CART

.014 Astato xs 20 guidewire 180cm for ALEGRA; 300cm for standard

Piggyback wire converter 4fr x 145 (or finecross, confirm)

26F Dryseal

14mm Armada Balloon

SL1

Baylis Needle

Bovie pen

Grounding Pad


MISC SUPPLIES

(3) Watchdog devices

(3) 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

(2) 6F JR4 Guide

6F JL3.5 Guide

5F MPA1

6F Straight Pigtail

5/6 Slender Sheath

25mm Gooseneck snare (Able to utilized this snare for both wire grasps)

Preclose x 4

0 Ethibond

0 Prolene

TR-Band

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.

After radial access Grandslam advanced to determine if Sentinal can be utilized. Grandslam removed until all access are obtain.

Preclose LFA x 1 and 8F sheath inserted for IABP

Preclose RFV x 2 and dryseal inserted over super stiff wire

6F Pigtail advanced for arch shot (20 for 20) for sentinel.

Grandslam and Sentinal advanced. Pigtail removed after sentinel in position.

Balloon pump advanced.

SL1- transeptal puncture

Exchange SL1 for two .032 wires

Agilis x 2 inserted

6F PA floated through one of the Agilis over runthrough

6F 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 Gooseneck snare through JL3.5 next to runthrough

(if ballooning leaflet for LVOT obstruction make sure "flying-V" isn't added to wire until after 5.0 x 20 compliant balloon is utilized)

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.

Pacer inserted.

Leaflet lacerated.

Lampoon system deconstructed. (May need SL1, 032 wire and agilis to regain transeptal access; so quickly reprep one agilis)

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