Open MVI: Difference between revisions

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Hybrid OR Procedure
Hybrid OR Procedure


[[File:MVRskirt.jpg|thumb|150px|right|Gore-Tex skirt on valve]]
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588478/
[[File:MVRskirt.jpeg|thumb|150px|right|Gore-Tex skirt on valve<BR>
*7-0 Prolene<BR>
*.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


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588478/


*2 CL staff needed- 1 scrub 1 circulator/monitor
*2 CL staff needed- 1 scrub 1 circulator/monitor
*Leave carts in the hall
*Leave carts in the hall
*small cath table and small utility table in room for valve prep


*One long table for all equipment
*Attach our leads in case we need to measure LVEDP
*IF Sentinel:
*IF Sentinel:
**Surgical incision made first so anticoagulation can be performed after
**Surgical incision made first so anticoagulation can be performed after
**Preprep device
**Preprep device
**Keep ACIST on cart and have ready to hook up, 100% contrast ok if creatnine ok
**Keep ACIST on cart and have ready to hook up, 100% contrast ok if creatnine ok
*IF CP Bypass cannulas inserted by IC
*IF CP Bypass cannulas inserted by IC
**8F sheath first used for pigtail- AOgram for sentinel
**8F sheath first used for pigtail- AOgram for sentinel
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*Don't open valve equipment until cannulas and sentinel in place (if using)
*Don't open valve equipment until cannulas and sentinel in place (if using)
*Remove C arm after sentinel/cannula placement.
*Remove C arm after sentinel/cannula placement.
*2 Commander setups used
 
**one for dilating graft
 
**one for valve- 2 indeflators if 29
*CTS secures Aortic Stent Graft
*Open valve according to OR policy
**Verify with MD prior to opening
**Give OR a copy of IFU
* Pigtail inserted preloaded with Safari wire
*Valve
**Valve needs to be mounted on balloon. **Edwards to get us information about aligning valve on balloon without fluoro.**
**Fill 38 indeflator to max to account for post dil placement (29)
* Pigtail inserted preloaded with Safari wire
*Remove Sentinel BEFORE PROTAMINE
*Remove Sentinel BEFORE PROTAMINE
*Move table out of the way. OR has it from here until TR band ready to be applied.


==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==
#Setup on small cath table for valve sewing and crimping, small utility table for extra stuff
#Pt. in room. A-line, swan etc.
#Surgeon starts sewing valve
#Prep and drape
#Cardiologist inserts femoral cannulae same as ECMO.
#Surgeon opens chest
#When old valve is exposed, pre-crimp valve and confirm
#Crimp when ready, insert Safari into Certitude, and cut wire short (~1 foot out the back of the Certitude)
#Remove surgical obstructions and position valve under fluoro.
#Deploy valve
#Remove Certitude
#Close


'''Post procedure thoughts'''


*Certitude delivery system?
*Bring Xray back in for stent graft and valve deployment


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

Latest revision as of 15:26, 24 January 2023

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 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
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