TMVI: Difference between revisions
From Bay Area Structural Heart Wiki
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*Dilate with 8F dilator | *Dilate with 8F dilator | ||
*Preclose | *Preclose | ||
*SL1 inserted over .032 260cm J ( Don't use wire that comes with SL1 - toss off table) | *SL1 inserted over .032 260cm J ( Don't use wire that comes with SL1 - toss off table) | ||
*Baylis needle inserted through SL1 and atrial septum puncture performed. | *Baylis needle inserted through SL1 and atrial septum puncture performed. |
Revision as of 19:26, 27 August 2021
Warning: This page needs revision!
Protip: Need Alcohol in lab for this procedure!
TransCatheter Mitral Valve Repair/Replacement
Per Rosalie:
TAVR/TMVI
- 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).
- 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
SHEATHS:
- Micropuncture
- 8fr Pinnacle for Perclose
- 8x35 Brite tip
- 8.5F SL1
- 8.5F Tourguide
- 16F E sheath, always, regardless of valve size.
WIRES:
Open
- 150 J wire
- .032 x 260 J-wire
- Safari 2
- Amplatz Super Stiff 1cm tip
CATHETERS
Open
- 6fr. Straight Pig
- 5fr. MPA2
- Naked 3 Port Manifold
PACING
- 5F Josephson Pacing Cable
- EP Quad Cable
- Remington Pacing Cable
- (2) Pacer Boxes
FOR EDWARDS VALVE
- INDEFLATOR
- CRIMPER
- E SHEATH
- DELIVERY SYSTEM
- VALVE
TRANS SEPTAL
- BAYLIS NEEDLE LARGE CURVE C1
- BAYLIS MACHINE
- BAYLIS CABLE
- GROUNDING PAD
SEPTAL DILATION
Open
- 12X4X75 MUSTANG for 23mm and 26mm sapien 14mm Armada for 29mm sapien
- PRESTO INDEFLATOR
Standby
- 9X4X75 MUSTANG
- 14, 16 XXL Balloons
- TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
- 10MM, 14MM, 18MM SEPTAL OCCLUDER
ADDITIONAL SUPPLIES
Open
- PERCLOSE
- PROBE COVER
- CHLORAPREP AND PREP TRAY
MEDICATIONS
- BUPIVACAINE
- EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE
- ROTAGLIDE 10ML (EDWARDS VALVE)
STANDBY EMERGENCY ECMO SUPPLIES
- 16F ARTERIAL CANNULA
- 21F VENOUS CANNULA
- (2) PERCLOSE
- ECMO INSTRUMENT TRAY
- AMPLATZ SUPER STIFF
STANDBY PERICARDIOCENTESIS SUPPLIES
- EYE DRAPE
- CHIBA NEEDLE 10CM 18G
- SKATER INTRODUCER SET
- BARD LOCKING PIGTAIL 6F OR 8F
- (3) 60ML SYRINGES
- STOPCOCK
- AMPLATZ SUPER STIFF 180CM
PROCEDURE:
- Patient prepped from navel to knees in sterile fashion.
- Access obtained with u/s
Typical sites:
14F OR 16F RFV E-sheath for valve delivery
- Dilate with 8F dilator
- Preclose
- SL1 inserted over .032 260cm J ( Don't use wire that comes with SL1 - toss off table)
- Baylis needle inserted through SL1 and atrial septum puncture performed.
- Needle removed, LA pressure recorded. .032 wire advanced to pulmonary vein
- MP advanced to LUPV, .032 wire removed and super stiff advanced
- MP and SL1 removed. E Sheath advanced.
- Tourguide advanced and directed to mitral valve.
- Pigtail and Safari2 inserted through tourguide for valve crossing.
- Safari2 wire inserted to ventricle. Simultaneous LA/LV pressure recorded.
- Pigtail and tourguide removed.
- 12mm/14mm balloon advanced for septostomy and possible BAV
- Balloon removed, valve delivery system advanced.
- When valve is in place, temp pacer inserted and tested.
- Valve deployed. Septum evaluated with echo for shunting.
- Delivery removed and SL1 readvanced.
- Pigtail advanced to LV, wire removed and simultaneous LA/LV pressures recorded.
- Pigtail and SL1 removed.
- Pacer removed.
- Preclosure completed and stitch to RFV
- 8F vein pulled and manual pressure applied
- Dermabond access site, no dressings needed.
APPROVED: MD initials MM/YY