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	Single plane 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)

• ACIST setup (if normal creatnine 100% contrast ok. only used for arch injection)

Open:

Wires:

• .032 260cm J wire
• .035 260cm J wire
• (2) .035 150cm J wire
• 300cm Grandslam
• Safari
• Amplatz SS 1cm
• .014 Astato xs 20 guidewire 300cm

Sheaths:

• 8F Sheath
• 7F Sheath
• 5/6 Slender Sheath
• 26F Dryseal

Catheters:

• 6F JR4 Guide
• 6F MP1 Guide
• 5F MPA1
• 6F Straight Pigtail

Misc:

• Perclose x 4
• Piggyback (??? Maybe finecross, verify preference)
  • have extra one on standby. May want to put one on either side of flying v.
• 0 Ethibond
• 0 Prolene x 2
• Naked Manifold (simultaneous pressure measurements post procedure)
• 6F PA Catheter
• (2) Watchdog devices
• (2) Stopcocks
• 4 hemostats
• (3) 60ml syringes
• (2) 12 inch extension tubing
• Bowl of D5
• Agilis SM Curl
• Priority Pack
• 14mm Armada Balloon
• 25mm Gooseneck snare
• Balloon Pump

Pacing:

• 8F 35cm Brite Tip Sheath
• Josephson Pacing Wire
• Remington Cable
• Blue Pacing Cable

Transseptal:

• SL1
• Baylis Needle
• Bovie pen
• Grounding Pad

Standby:

Sentinel- opened after grandslam wire across great vessels

Be Ready For:

ECMO

Alcohol Septal Ablation

ASD Closure

Rough Procedural Plan

1. Obtain access as listed above.
2. Preclose RFV x 2 and dryseal inserted, sutured with Ethibond
3. Balloon pump inserted
4. Pigtail to arch for injection prior to sentinel. 6fps DSA.
5. Sentinel inserted
6. SL1- transeptal puncture
7. 5F MP used for exchanging wires in LUPV
8. Amplatz SS advanced (do not go straight to agilis. put SS wire in for dryseal first)
9. SL1 exchanged for Dryseal
10. Agilis inserted through Dryseal
11. 6F PA floated through Agilis over guidewire into AO
12. Guidewire exchanged for Astato
13. 6F JR4 with gooseneck snare inserted through LFA.
14. Astato wire snared and pulled into JR4 Guide
15. PA catheter removed and 6F MP1 advanced over snared Astato.
16. Flying V formed on arterial side of wire
17. Finecross/Piggyback advanced over arterial side of astato wire
18. Flying V positioned over A2
19. Pacer Inserted
20. Cut at 50
21. Leaflet lacerated and verified on TEE
22. LAMPOON equipment removed
23. Pigtail advanced through Agilis
24. Safari wire inserted into LV
25. 14mm Armada used for atrial septostomy
26. Valve inserted and deployed
27. If a post deployment gradient is needed, balloon pump will be removed and short 8F sheath exchanged for 8F 90cm shuttle sheath.
28. 125cm pigtail inserted to LV. 2nd manifold needed.
29. Balloon Pump removed
30. Perclose LFA and RFA
31. Glue vs woggle depending on heparin reversal