Watchman

Watchman - Left Atrial appendage closure
Anesthesia	Imaging	Access	ACIST/manifold
General	Fluoro and TEE	14F RFV	One manifold with contrast
Pre-Procedure Watchouts
PRE PROCEDURE: Type and Screen

Type and Screen

Open

• Micropuncture
• 8.5fr SL1 sheath
• 8fr sheath (dilator used pre-Perclose)
• 16fr dilator
• Probe cover
• 1 Perclose
  • 0-Prolene or 0-PDS (Spies will add a suture after perclose if site is oozing. If no ooze Exofin.)

• Amplatz Super Stiff .035x260 1cm tip

• Cordis 150J

• .032 x 260

• 5fr Straight Pigtail
• 5fr MPA2 (Spies)
• 3-port manifold
• SL1 Fast-Cath
• Large curve C1 Baylis needle
• Baylis cable
• Grounding pad

Standby

• 4 or 5fr Pinnacle for Arterial line

• 190 Supracore
• Wholey / Versacore

Watchman supplies:

• 14fr Watchman access sheath (Open as requested after TEE)
• Watchman device (Size as requested after TEE)

PROCEDURE

1. Basic table set up ONLY until it is determined by TEE that case will proceed.
2. TEE performed. Procedure aborted if clot
3. Prep bilateral groins and drape once probe has been inserted.
4. Micropuncture ultrasound-guided RFV access
5. 5 Fr Micropuncture sheath
6. Baby J wire from sheath
7. 8 Fr dilator
8. 6 Fr Perclose pre-close RFV. .032 wire inserted after preclosure deployment.
9. 8.5 Fr SL 1 Sheath
10. Baylis needle inserted
11. TEE & fluoro guided transeptal access & images of Left Atrial Appendage
12. Anesthesia gives Heparin IV. ACT GOAL >250-300
13. Transeptal puncture
14. Needle removed and .032 wire inserted to advance SL1 into LA
15. Measure LA pressure
16. MPA preloaded with J wire inserted through SL1
17. J wire removed and 260cm SS Amplatz advanced to LA (preshaped by MD)
18. Straight 260cm Super Stiff Amplatz wire to LUPV
19. MPA and SL1 removed
20. 14 Fr WATCHMAN delivery sheath either SINGLE, DOUBLE or ANTERIOR Curve
21. 5 Fr Str Pigtail advanced to the LAA
22. Hook pigtail up to manifold for angiogram of LAA
23. Measure and select size of Watchman device
24. Open and prep Watchman Device -
    • Open touhy
    • Exercise delivery
    • Advance feet of device to just inside of marker
    • Leave touhy open and attach to manifold with pressurized hep saline open, close touhy and flush to device. Tap through delivery system while flushing. (Size: 21, 24, 27, 30, 33mm)
25. Pigtail removed just prior to delivery system insertion.
26. Insert delivery with a wet-to-wet connection (leaving pressurized saline on)
27. Once inserted, begin filling delivery system with contrast. Delivery system takes 20ml to fill.
28. Deploy Device. Confirm placement to meet PASS criteria: Position Anchor, Size, Seal. Can be recaptured/reposition. Fully unscrew to deploy device.
29. Placement confirmed by LA angiogram
30. Delivery system removed as MD tamps perclose knot.
31. If access is clean, Dermabond. If bleeding, woggle.

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APPROVED: MD initials MM/YY