Open MVI

Hybrid OR Procedure

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

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

Supplies

Open

• TAVR pack
• Certitude system
• Crimper
• 29 valve
• 38 indeflator
• Safari wire
• 2x Perclose
• 8fr Pinnacle sheath
• Micropuncture

Standby

• Sentinel

Bring

• TAVI cart
• CL to-go cart
• Small cath table
• Very small utility table

• 2 CL staff needed- 1 scrub 1 circulator/monitor
• Leave carts in the hall
• small cath table and small utility table in room for valve prep

• 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.

• Remove Sentinel BEFORE PROTAMINE

Procedure

1. Setup on small cath table for valve sewing and crimping, small utility table for extra stuff
2. Pt. in room. A-line, swan etc.
3. Surgeon starts sewing valve
4. Prep and drape
5. Cardiologist inserts femoral cannulae same as ECMO.
6. Surgeon opens chest
7. When old valve is exposed, pre-crimp valve and confirm
8. Crimp when ready, insert Safari into Certitude, and cut wire short (~1 foot out the back of the Certitude)
9. Remove surgical obstructions and position valve under fluoro.
10. Deploy valve
11. Remove Certitude
12. Close