Micra post TAVI: Difference between revisions
From Bay Area Structural Heart Wiki
(Created page with "In the course of a TAVI, it is sometimes necessary to implant a leadless pacemaker. This facility uses the Micra device. This page will guide you on this procedure in the post...") |
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| Line 11: | Line 11: | ||
*0 PDS or Prolene | *0 PDS or Prolene | ||
*180 Amplatz Super Stiff, 7cm tip | *180 Amplatz Super Stiff, 7cm tip | ||
*Micra sheath from behind EP | |||
If pt. is dependent on TPM and it is in the RFV, assume you will be switching the TPM to the LFV and open: | If pt. is dependent on TPM and it is in the RFV, assume you will be switching the TPM to the LFV and open: | ||
| Line 17: | Line 18: | ||
*5fr. Ballon tip TPM catheter | *5fr. Ballon tip TPM catheter | ||
Prep: | ===Prep:=== | ||
*Set ACIST at 5ml/sec, 20ml total (to fill syringes). | *Set ACIST at 5ml/sec, 20ml total (to fill syringes). | ||
* | *20 and 60cc syringes filled with Hep Saline | ||
*Flush and assemble Micra Sheath | |||
*Anesthesia preps for 125cc/hr Hep Saline infusion | |||
===Procedure:=== | |||
====If on TPM==== | |||
#Access LFV and insert 8.5 Brite Tip | |||
#Insert balloon-tip TPM and establish capture | |||
#Wire RFV with Amplatz SS | |||
#Dilate and place Micra sheath | |||
#Attach Hep Saline drip | |||
#Micra delivery system is flushed gently with 60cc syringe and inserted | |||
#Fill delivery system with contrast | |||
#Before deployment, do LAO with contrast | |||
#Do RAO with saline flush (clears delivery system) | |||
#Deploy Micra | |||
#Tug test under 30 fps. cine | |||
#Flush delivery system with full 60 cc syringe | |||
#Pull suture | |||
#Remove delivery system | |||
#Place purse-string and woggle | |||
#Remove sheath | |||
Revision as of 22:38, 5 August 2021
In the course of a TAVI, it is sometimes necessary to implant a leadless pacemaker. This facility uses the Micra device. This page will guide you on this procedure in the post-TAVI setting.
Already on the table:
- Micropuncture set
- 150 j-wire
- 2x 20cc syringes
- 1-2x 60cc syringes
Open:
- 14 and 22 coons dilators
- 0 PDS or Prolene
- 180 Amplatz Super Stiff, 7cm tip
- Micra sheath from behind EP
If pt. is dependent on TPM and it is in the RFV, assume you will be switching the TPM to the LFV and open:
- New ultrasound probe cover
- 8.5 x 35 Brite-tip sheath
- 5fr. Ballon tip TPM catheter
Prep:
- Set ACIST at 5ml/sec, 20ml total (to fill syringes).
- 20 and 60cc syringes filled with Hep Saline
- Flush and assemble Micra Sheath
- Anesthesia preps for 125cc/hr Hep Saline infusion
Procedure:
If on TPM
- Access LFV and insert 8.5 Brite Tip
- Insert balloon-tip TPM and establish capture
- Wire RFV with Amplatz SS
- Dilate and place Micra sheath
- Attach Hep Saline drip
- Micra delivery system is flushed gently with 60cc syringe and inserted
- Fill delivery system with contrast
- Before deployment, do LAO with contrast
- Do RAO with saline flush (clears delivery system)
- Deploy Micra
- Tug test under 30 fps. cine
- Flush delivery system with full 60 cc syringe
- Pull suture
- Remove delivery system
- Place purse-string and woggle
- Remove sheath
