Valve in MAC with Antegrade Lampoon: Difference between revisions

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General Anesthesia, TEE
{| class="wikitable"
! colspan="4" |Valve in MAC with Antegrade Lampoon
|-
!Anesthesia
!Imaging
!Access
!ACIST/manifold
|-
|General
L Radial art line
|Fluoro and TEE
|
*26F RFV (For transeptal equipment) (No need for E-Sheath)
*8F LFA(For IABP and Pigtial for arch shot)
*6F RRA (For Sentinel)
|One manifold with contrast
|-


! colspan="4" |Pre-Procedure Watchouts
|-
| colspan="4" |
PRE PROCEDURE: TYPE AND CROSS, ASPIRIN GIVEN
|-
|}


MAC- Mitral Annular Calcification


https://www.jtcvs.org/article/S0022-5223(18)31545-9/pdf


===Per Rosalie:===
TAVR/TMVI
#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).
#Medtronic Core Valve – all items are charge separately.  Scan all barcodes (delivery system, loading system and valve).
===Access sites:===
===Access sites:===
24F RFV
*26F RFV (For transeptal equipment) (No need for E-Sheath)       
 
*8F LFA(For IABP and pigtail for arch shot)
8F LFV
*6F RRA (For Sentinel)
 
8F LFA
<br />


==Supplies:==
===Open:===
===Open:===
Standard Basilica Equipment
====FROM STRUCTURAL HEART CART====
 
*.014 Astato xs 20 guidewire 180cm for ALEGRA; 300cm for standard
Standard Transeptal Equipment
*Piggyback wire converter 4fr x 145 (or finecross, confirm)
 
*26F Dryseal
Standard TMVR Equipment
*14mm Armada Balloon
 
*SL1
??Sentinel Equipment**
*Baylis Needle
 
*Bovie pen
Safari
*Grounding Pad
 
24F Dryseal
 
(2) Agilis sm curl
 
300 cm Runthrough wire
 
14mm Armada Balloon


Balloon Pump
===MISC SUPPLIES===
*(3) Watchdog devices
*(3) Stopcocks
*4 hemostats
*(3) 60ml syringes
*(2) 12 inch extension tubing
*Extra bowl for D5
*(2) Agilis SM Curl
*Priority Pack
*Balloon Pump
*Sentinel- opened after grandslam wire across great vessel


6F JR4 Guide/ 6F MP
===FROM ROOM SUPPLIES===
 
*6F PA Catheter
6F JL3.5 Guide
*(2) .032 260cm J wire
 
*.035 260cm J wire
7F JR4 Guide
*.035 150cm J wire
 
*300cm Grandslam
18/30 Ensnare
*300 cm Runthrough wire
 
*Safari
25mm Gooseneck snare
*Amplatz SS 1cm
 
*(2) 8F Sheath
Preclose x 2
*5/6 Slender Sheath
 
*(2) 6F JR4 Guide
0 Ethibond
*6F JL3.5 Guide
 
*5F MPA1
0 Prolene
*6F Straight Pigtail
<br />
*25mm Gooseneck snare  
*Preclose x 2
*0-Ethibond
*0-Prolene on a Ct-1 Needle for Woggle
*TR-Band


===Standby:===
===Standby:===
12F Flexcath
*12F Flexcath
 
*6F MP Guide
6F MP Guide
*8F 90cm Shuttle sheath and 125cm Pigtail for measuring gradient post valve placement '''Standby Items FROM STORE ROOM'''
 
**8F 35cm Brite Tip Sheath
7F Langston
**Josephson Pacing Wire
<br />
**Remington Cable
**Blue Pacing Cable


===Rough Procedural Plan:===
===Rough Procedural Plan:===
Obtain access as listed above.
#Obtain access as listed above.
 
#After radial access Grandslam advanced to determine if Sentinal can be utilized. Grandslam removed until all access are obtain.
Preclose RFV x 2
#Preclose LFA x 1 and 8F sheath inserted for IABP
 
#Preclose RFV and dryseal inserted over super stiff wire
SL1- transeptal puncture
#6F Pigtail advanced for arch shot (hand injection with manifold, NO DSA) for sentinel.
 
#Grandslam and Sentinal advanced. Pigtail removed after sentinel in position.
SL1 exchanged for 24F Dryseal
#SL1- transeptal puncture
 
#Exchange SL1 for two .032 wires
Agilis x 2 inserted
#Agilis x 2 inserted
 
#6F PA floated through one of the Agilis over runthrough
7F JR4 with ensnare to LFA
#6F JR4 with ensnare inserted through LFA. Runthrough snared in LV.
 
#PA catheter removed and 6F JL3.5 advanced over snared runthrough
6F JR4 through one of the agilis.
#6F JR4 through other agilis.
 
#Lampoon equipment advanced through 6F JR4
Runthrough in 6F JR4 and snared through 7F in LV
#25mm Gooseneck snare through JL3.5 next to runthrough
 
#*(if ballooning leaflet for LVOT obstruction make sure "flying-V" isn't added to wire until after 5.0 x 20 compliant balloon is utilized)
6F JR4 removed and reinserted over .032 wire---- or '''6FMP'''??
#Anterior leaflet traversed.-- Test bovie at 30 cut. Increase to 70 cut for traversal and laceration.
 
#After leaflet traversal and system snared- guide and Runthrough removed.
Lampoon equipment advanced through 6F JR4/MP
#Balloon pump advanced.
 
#Leaflet lacerated.
6FJL3.5 advanced over Runthrough
#Lampoon system deconstructed. (May need SL1, 032 wire and agilis to regain transeptal access; so quickly reprep one agilis)
 
#Pigtail advanced with Safari
25mm snare through JL3.5
#Pigtail out. Unipolar pacing tested.  
 
#Septostomy.
Anterior leaflet traversed.-- Test bovie at 30 cut. Increase to 70 cut for traversal and laceration.
#Valve inserted and deployed.
 
#Pigtail for wire exchange
After leaflet traversal and system snared- 7F guide and Runthrough removed.
#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 inserted.
 
Pacer inserted.
 
Leaflet lacerated.
 
Lampoon system deconstructed.
 
Pigtail advanced with Safari
 
Pigtail out.
 
Septostomy
 
Valve inserted and deployed.
 
Pigtail for wire removal
 
 
 
 
<nowiki>*</nowiki>ECMO??
 
<nowiki>*</nowiki>Possible ASD Closure


<nowiki>*</nowiki>Flow monitor on left leg?
*ECMO??
*Possible ASD Closure


[[Category:Procedures]]
[[Category:Procedures]]

Latest revision as of 17:17, 8 September 2022

Valve in MAC with Antegrade Lampoon
Anesthesia Imaging Access ACIST/manifold
General

L Radial art line

Fluoro and TEE
  • 26F RFV (For transeptal equipment) (No need for E-Sheath)
  • 8F LFA(For IABP and Pigtial for arch shot)
  • 6F RRA (For Sentinel)
One manifold with contrast
Pre-Procedure Watchouts

PRE PROCEDURE: TYPE AND CROSS, ASPIRIN GIVEN


Per Rosalie:

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:

  • 26F RFV (For transeptal equipment) (No need for E-Sheath)
  • 8F LFA(For IABP and pigtail for arch shot)
  • 6F RRA (For Sentinel)

Supplies:

Open:

FROM STRUCTURAL HEART CART

  • .014 Astato xs 20 guidewire 180cm for ALEGRA; 300cm for standard
  • Piggyback wire converter 4fr x 145 (or finecross, confirm)
  • 26F Dryseal
  • 14mm Armada Balloon
  • SL1
  • Baylis Needle
  • Bovie pen
  • Grounding Pad

MISC SUPPLIES

  • (3) Watchdog devices
  • (3) Stopcocks
  • 4 hemostats
  • (3) 60ml syringes
  • (2) 12 inch extension tubing
  • Extra bowl for D5
  • (2) Agilis SM Curl
  • Priority Pack
  • Balloon Pump
  • Sentinel- opened after grandslam wire across great vessel

FROM ROOM SUPPLIES

  • 6F PA Catheter
  • (2) .032 260cm J wire
  • .035 260cm J wire
  • .035 150cm J wire
  • 300cm Grandslam
  • 300 cm Runthrough wire
  • Safari
  • Amplatz SS 1cm
  • (2) 8F Sheath
  • 5/6 Slender Sheath
  • (2) 6F JR4 Guide
  • 6F JL3.5 Guide
  • 5F MPA1
  • 6F Straight Pigtail
  • 25mm Gooseneck snare
  • Preclose x 2
  • 0-Ethibond
  • 0-Prolene on a Ct-1 Needle for Woggle
  • TR-Band

Standby:

  • 12F Flexcath
  • 6F MP Guide
  • 8F 90cm Shuttle sheath and 125cm Pigtail for measuring gradient post valve placement Standby Items FROM STORE ROOM
    • 8F 35cm Brite Tip Sheath
    • Josephson Pacing Wire
    • Remington Cable
    • Blue Pacing Cable

Rough Procedural Plan:

  1. Obtain access as listed above.
  2. After radial access Grandslam advanced to determine if Sentinal can be utilized. Grandslam removed until all access are obtain.
  3. Preclose LFA x 1 and 8F sheath inserted for IABP
  4. Preclose RFV and dryseal inserted over super stiff wire
  5. 6F Pigtail advanced for arch shot (hand injection with manifold, NO DSA) for sentinel.
  6. Grandslam and Sentinal advanced. Pigtail removed after sentinel in position.
  7. SL1- transeptal puncture
  8. Exchange SL1 for two .032 wires
  9. Agilis x 2 inserted
  10. 6F PA floated through one of the Agilis over runthrough
  11. 6F JR4 with ensnare inserted through LFA. Runthrough snared in LV.
  12. PA catheter removed and 6F JL3.5 advanced over snared runthrough
  13. 6F JR4 through other agilis.
  14. Lampoon equipment advanced through 6F JR4
  15. 25mm Gooseneck snare through JL3.5 next to runthrough
    • (if ballooning leaflet for LVOT obstruction make sure "flying-V" isn't added to wire until after 5.0 x 20 compliant balloon is utilized)
  16. Anterior leaflet traversed.-- Test bovie at 30 cut. Increase to 70 cut for traversal and laceration.
  17. After leaflet traversal and system snared- guide and Runthrough removed.
  18. Balloon pump advanced.
  19. Leaflet lacerated.
  20. Lampoon system deconstructed. (May need SL1, 032 wire and agilis to regain transeptal access; so quickly reprep one agilis)
  21. Pigtail advanced with Safari
  22. Pigtail out. Unipolar pacing tested.
  23. Septostomy.
  24. Valve inserted and deployed.
  25. Pigtail for wire exchange
  26. 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.
  • ECMO??
  • Possible ASD Closure