Open MVI

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

Note: 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

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.

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