Open MVI: Difference between revisions

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==Procedure==
==Procedure==
===Setup===
*Arrange valve prep equipment on cath table
*Fluids as per usual for TAVR
**1L Hep saline in medium and wire bowls
**1L NACL in 2 bowls
**30cc Visi in bowl
*Remove all gauze and countables. Keep 18g access needle, scalpel, and instruments.
#Setup on small cath table for valve sewing and crimping, small utility table for extra stuff
#Setup on small cath table for valve sewing and crimping, small utility table for extra stuff
#Pt. in room. A-line, swan etc.
#Pt. in room. A-line, swan etc.

Revision as of 15:49, 27 October 2021

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

OR supplies cannula and Amplatz SS wires. Dave doesn’t like their 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