TMVI

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Protip: Need Alcohol in lab for this procedure!

TransCatheter Mitral Valve Repair/Replacement

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).

MITRAL CLIP (Mitral/Tricuspid):

1. Use the barcode on Mckesson screen in Lab 1 – Mitraclip (Abbott) bundle consists of (1) Steerable Guide Catheter, (2) NTR Clip Delivery System & (1) XTR Clip Delivery System.

TMVR
Anesthesia	Imaging	Access	Pre-Procedure
General Anesthesia A-Line	Single Plane Fluoro TEE No Acist Unipolar pacing	RVF pre-closed x 1	Type and Cross Aspirin Given

Open:

SHEATHS:

• Micropuncture
• 8fr Pinnacle for Perclose
• Perclose (If Spies is primary, NO perclose if Daniles is primary.)
• 16F E sheath, always, regardless of valve size.

WIRES:

• 150 J wire
• .032 x 260 J-wire
• Safari 2
• Amplatz Super Stiff 1cm tip

TRANSEPTAL EQUIPMENT:

• 8.5F SL1
• Baylis Needle
• Baylis cable
• Grounding pad
• 8.5F Agilis

MISC:

• Naked 3 Port Manifold
• Alligator pacing cable

CATHETERS:

• 6fr. Straight Pig
• 5fr. MPA2

SEPTAL DILATION:

• 12X4X75 MUSTANG for 23mm and 26mm Sapien OR 14mm Armada for 29mm Sapien
• PRESTO INDEFLATOR

BIPOLAR PACING ON STANDBY:

• 8x35 Brite tip
• 5F Josephson Pacing Cable
• EP Quad Cable
• Remington Pacing Cable
• (2) Pacer Boxes

FOR EDWARDS VALVE:

• Indeflator (Second Indeflator on standby)
• Crimper
• E-sheath (Second E-Sheath on standby)
• Delivery system (Second delivery on standby)
• Valve

Standby

• 9X4X75 MUSTANG
• 14, 16 XXL Balloons
• TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
• 10MM, 14MM, 18MM SEPTAL OCCLUDER

MEDICATIONS

• BUPIVACAINE
• EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE
• ROTAGLIDE 10ML (EDWARDS VALVE)

PROCEDURE:

• Patient prepped from navel to knees in sterile fashion.  
• Access obtained with u/s
• Dilate with 8F dilator
• Preclose
• SL1 inserted over .032 260cm J ( Don't use wire that comes with SL1 - toss off table)
• Baylis needle inserted through SL1 and atrial septum puncture performed.
• Needle removed, LA pressure recorded. .032 wire advanced to pulmonary vein
• MP advanced to LUPV, .032 wire removed and super stiff advanced
• MP and SL1 removed. E Sheath advanced.
• Agilis advanced and directed to mitral valve.
• Pigtail and Safari2 inserted through Agilis for valve crossing.
• Safari2 wire inserted to ventricle. Simultaneous LA/LV pressure recorded.
• Pigtail and Agilis removed.
• 12mm/14mm balloon advanced for septostomy and possible BAV
• Balloon removed, valve delivery system advanced.
• When valve is in place, black alligator cable attached and pacing tested.
• Valve deployed. Septum evaluated with echo for shunting.
• Delivery removed and SL1 re-advanced.
• Pigtail advanced to LV, wire removed and simultaneous LA/LV pressures recorded (maybe).
• Pigtail and SL1 removed.
• Pacer removed.
• Preclosure completed and stitch to RFV
• Dermabond access site, no dressings needed.

STANDBY EMERGENCY ECMO SUPPLIES

• 16F ARTERIAL CANNULA

• 21F VENOUS CANNULA
• (2) PERCLOSE
• ECMO INSTRUMENT TRAY
• AMPLATZ SUPER STIFF

STANDBY PERICARDIOCENTESIS SUPPLIES

• EYE DRAPE
• CHIBA NEEDLE 10CM 18G
• SKATER INTRODUCER SET
• BARD LOCKING PIGTAIL 6F OR 8F
• (3) 60ML SYRINGES
• STOPCOCK
• AMPLATZ SUPER STIFF 180CM

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