Open MVI

Hybrid OR Procedure

Gore-Tex skirt on valve
*7-0 Prolene
*.04 Gore-tex

Supplies

Open

• Certitude system
• Crimper
• 29 valve
• 38 indeflator
• Safari wire

Standby

• Sentinel
• TAVI cart
• CL to-go cart

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588478/

• 2 CL staff needed- 1 scrub 1 circulator/monitor
• Leave carts in the hall

• One long table for all equipment
• Attach our leads in case we need to measure LVEDP
• IF Sentinel:
  • Surgical incision made first so anticoagulation can be performed after
  • Preprep device
  • Keep ACIST on cart and have ready to hook up, 100% contrast ok if creatnine ok
• IF CP Bypass cannulas inserted by IC
  • 8F sheath first used for pigtail- AOgram for sentinel
  • Preclose A x 2
  • Standard ECMO equipment
• Don't open valve equipment until cannulas and sentinel in place (if using)
• Remove C arm after sentinel/cannula placement.
• 2 Commander setups used
  • one for dilating graft
  • one for valve- 2 indeflators if 29
• CTS secures Aortic Stent Graft
• Open valve according to OR policy
  • Verify with MD prior to opening
  • Give OR a copy of IFU
• Pigtail inserted preloaded with Safari wire
• Valve
  • Valve needs to be mounted on balloon. **Edwards to get us information about aligning valve on balloon without fluoro.**
  • Fill 38 indeflator to max to account for post dil placement (29)
• Pigtail inserted preloaded with Safari wire
• Remove Sentinel BEFORE PROTAMINE
• Move table out of the way. OR has it from here until TR band ready to be applied.

Post procedure thoughts

• Certitude delivery system?
• Bring Xray back in for stent graft and valve deployment