Tip to Base Lampoon

Tip to Base Lampoon, also referred to as "Reverse Lampoon". Performed when VIV Mitral will likely cause LVOT obstruction.

VIV Mitral with Tip to Base Lampoon
Anesthesia	Imaging	Access	ACIST/manifold
General	Biplane Fluoro and TEE	Femoral Vein x2 Femoral Artery x2 R Radial Artery	ACIST with 100% contrast ok if normal creat One manifold with contrast One naked manifold
Pre-Procedure Watchouts
Request alcohol from pharmacy

TAVR/TMVI

1. 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).
2. Medtronic Core Valve – all items are charge separately.  Scan all barcodes (delivery system, loading system and valve).

Access Sites:

• 7F RFA
• 26F RFV (primary access)
• 7.5F LFA (for balloon pump)
• 8FLFV (for pacer)

Open:

• .014 Astato xs 20 guidewire 300cm
• Piggyback (??? Maybe finecross, verify preference)
  • have extra one on standby. May want to put one on either side of flying v.
• 26F Dryseal
• 14mm Armada Balloon
• 25mm Gooseneck snare
• SL1
• Baylis Needle
• Bovie pen
• Grounding Pad

MISC SUPPLIES

• (2) Watchdog devices
• (2) Stopcocks
• 4 hemostats
• (3) 60ml syringes
• (2) 12 inch extension tubing
• Bowl of D5
• Agilis SM Curl
• Priority Pack
• Balloon Pump
• ACIST setup (if normal creatnine 100% contrast ok. only used for arch injection)
• Naked Manifold (simultaneous pressure measurements post procedure)
• 8F 35cm Brite Tip Sheath
• Josephson Pacing Wire
• Remington Cable
• Blue Pacing Cable

Sentinel- opened after grandslam wire across great vessels

FROM ROOM SUPPLIES

• 6F PA Catheter
• .032 260cm J wire
• .035 260cm J wire
• (2) .035 150cm J wire
• 300cm Grandslam
• Safari
• Amplatz SS 1cm
• 8F Sheath
• 7F Sheath
• 6F JR4 Guide
• 6F MP1 Guide
• 5F MPA1
• 6F Straight Pigtail
• 5/6 Slender Sheath
• Perclose x 4
• 0 Ethibond
• 0 Prolene x 2

Be Ready For:

ECMO

Alcohol Septal Ablation

ASD Closure

Rough Procedural Plan

Obtain access as listed above.

Preclose RFV x 2 and dryseal inserted, sutured with Ethibond

Balloon pump inserted

Pigtail to arch for injection prior to sentinel. 6fps DSA.

Sentinel inserted

SL1- transeptal puncture

5F MP used for exchanging wires in LUPV

Amplatz SS advanced (do not go straight to agilis. put SS wire in for dryseal first)

SL1 exchanged for Dryseal

Agilis inserted through Dryseal

6F PA floated through Agilis over guidewire into AO

Guidewire exchanged for Astato

6F JR4 with gooseneck snare inserted through LFA.

Astato wire snared and pulled into JR4 Guide

PA catheter removed and 6F MP1 advanced over snared Astato.

Flying V formed on arterial side of wire

Finecross/Piggyback advanced over arterial side of astato wire

Flying V positioned over A2

Pacer Inserted

Cut at 50

Leaflet lacerated and verified on TEE

LAMPOON equipment removed

Pigtail advanced through Agilis

Safari wire inserted into LV

14mm Armada used for atrial septostomy

Valve inserted and deployed

If a post deployment gradient is needed, balloon pump will be removed and short 8F sheath exchanged for 8F 90cm shuttle sheath. 125cm pigtail inserted to LV. 2nd manifold needed.

Balloon Pump removed

Perclose LFA and RFA

Glue vs woggle depending on heparin reversal