TMVI - Encircle Sapien M3

Protip: Need Alcohol in lab for this procedure!

Warning:
THIS IS A RESEARCH PROCEDURE. ALL EDWARDS EQUIMENT WILL BE SUPPLIED BY THE RESEARCH TEAM.
DO NOT THROW AWAY ANY BOXES.

Warning: If broadcasting case:
DO NOT PUT PATIENT INFO INTO MCKESSON OR XRAY. PHI CANNOT BE STREAMED.
CASE INFO WILLL NEED TO BE MERGED AFTER THE PROCEDURE.

Sapien M3
Anesthesia	Imaging	Access	Pre-Procedure
General Anesthesia A-line Possible Swan	Single plane fluoro 100% contrast in ACIST TEE	RFV pre-closed x 1 LFV for Pacer	Stabilizer placement prior to draping: 69cm from mid-sternum

Open:

• Micropuncture set
• 8f Pinnacle
• 8fr x 35cm Brite-Tip
• 8.5fr SL1 transseptal sheath
• 22F coons dilator (or larger if we have it)
• (1) .035 150cm J wire
• (1) .035 260cm J wire
• (1) .032 260cm J wire
• (1) Safari Wire
• (1) Amplatz SS 260cm 1cm Tip
• (1) 6F Straight Pigtail
• 5F MPA1 125
• 5F Josephson Pacing Cable
• EP Quad Cable
• Remington Pacing Cable
• Extra Sterile Bowl (3- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX)
• 1.5L Normal Saline
• 500ml Heparinized Saline
• (3) 60ml Syringe
• (3) 20ml Syringe
• (2) High Pressure stopcock
• Baylis needle
• Baylis cable
• (1) Heparin tubing (updated with new device)
• (1) 72” pressure tubing (updated with new device)
• Extra manifold (For a gradient at the end)
• Perclose  
• (3-4) 20ml syringes for flush (For DDS and sheath)
• 0-Prolene

Standby:

• Baylis ProTrack wire
• 6F ballon wedge
• 2530 Edwards indeflator
• 14X4 Armada Balloon
• PRESTO INDEFLATOR
• TORQUEVUE 45 DEGREE DELIVERY SYSTEM (9F OR 10F)
• 10MM, 14MM, 18MM SEPTAL OCCLUDER

Nurse Notes:

• ACIST- 100% CONTRAST
• 1L Hep Saline on Alaris IV pump set at: Pressure: 400 mmHg Rate: 400ml/hr - Click this link to see pressure adjustment process
• GROUNDING PAD
• BAYLIS MACHINE
• (2) Pacer Boxes
• Patient prepped from navel to knees in sterile fashion.  
• (1) Alaris pump (updated with new device)

MEDICATIONS

• Bupivicaine/Lidocaine Mixed 10mL each
• Epinephrine 10mcg/mL in red syringe on back table
• Rotaglide 10mL for sheath before valve is inserted

STANDBY EMERGENCY ECMO SUPPLIES

• 16F Arterial Cannula
• 21F Venous Cannula
• (2) Perclose
• ECMO Instrument Tray
• Amplatz SS 7cm tip

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

STANDBY PARAVALVULAR LEAK REPAIR SUPPLIES

SEE MITRAL PARAVALVULAR LEAK REPAIR

• AMPLATZER VASCULAR PLUG 2 SIZE 8-18 AVAILABLE

PROCEDURE

• Access obtained with u/s
• Need 20 and 60 cc flush on front table for the delivery system.
• 8F 35cm LFV for transcutaneous pacing
• RFV
• Dilate with 8F
• Preclose
• SL1 inserted over .032x260 wire
• Baylis needle inserted through SL1 and atrial septum puncture performed.
• Needle removed
• 5F MPA advanced over .032 wire
• 1cm Amplatz Super Stiff advanced and MPA and SL1 removed
• 23fr. Delivery sheath(GS) - Used for Doc and valve advanced
• Pigtail advanced across the mitral valve and LVgram @ 15/45 performed
• Mitral annulus denoted on live monitor screen in A plane
• DDS prepped
  • 1L Hep. Saline (2U/ml) bag with pressure bag spiked with heparin tubing, flushed, and attached to pump
  • Alaris settings 400ml/hr occlusion pressure limit 400mm Hg
  • Pressure tubing attached to stopcock and DDS
  • Swiftlink cover installed over pressure tubing and secured ~18” from off-table end
  • After hookup and flush, Swiftlink cover can be slid over heparin tubing for additional slack on the table.
• Dock Delivery System (DDS) advanced through GS
• Dock deployed in a timely fashion ;)
• Temp pacer inserted and tested.
• DDS removed and Pigtail inserted over exchange  J for valve crossing
• J wire exchanged for Safari 2
• Pigtail and GS removed
• Balloon removed
• Valve delivery system advanced
• Valve deployed. Septum evaluated with echo for shunting and PVL.
  • remind MD to lower FIO2*** Delivery system removed and MPA inserted for LA pressure measurement.
• (RHC performed with 6F swan to evaluate ASD)
• Safari retained across septum until shunt is evaluated
• All equipment removed
• Preclosure closed and stitch to RFV, manual pressure LFV
• Woggle vs Dermabond depending on Protamine

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APPROVED: MD initials MM/YY