TEER with PASCAL

Anethesia	Imaging	Access
General	Fluoro, TEE	4F Femoral Vein for drawing ACT's **If functional MR/low EF Anesthesia to obtain A line and femoral venous sheath not needed
Pre-Procedure Watchouts
** Tidal Volume during time-out!

Big Equipment:

• Cath pack
• Clear Plexiglass base support
• Non-Sterile stabilizer provided by Rep
• Baylis generator

* NEW - Baylis Transseptal

• VersaCross system
• Grounding pad

Bellow items on standby!

• SL1 sheath
• Large curve Baylis needle
• Baylis cable

Note: When using the Philips 4D ICE probe use a 10F 30 cm (from EP) sheath for ACT draws.

Wires:

• .032 X 260 “J” wire
• Amplatz SuperStiff 1cm Tip 260cm

Catheters:

• 5F MPA2

Misc supplies:

• 4fr. Pinnacle sheath for ACT (not needed if anesthesia has an A line.)
• Micropuncture
• 8F Sheath for dilator only
• (1)Perclose (If Spies is primary, NO perclose if Daniles is primary.)
• 0-prolene Suture for woggle
• (2) 60cc syringe
• Sterile towel pack for back table
• Naked 3-port manifold to measure LA pressure only
• Fluoro cover to anesthesia IV pole or moving xray shield
• U/S probe cover
• back table cover
• Large and small bowl for back table

Standby

• 20fr. DrySeal for recovering wire to LUPV
• 8x40 135cm Mustang balloon
• 12fr. Short Cook sheath

Procedure

• Anesthesia will obtain radial art line prior to draping.
• Pre procedure TEE imaging performed

• Prior to prepping patient, place MitraClip Plate (plexiglass board – hinge side up) under patient’s leg off center to the right. Place PASCAL Lift (step stool) over patients right leg. Make sure there is direct contact between stool and plate.

• Prep patient and drape per usual. Drape anesthesia pole and/or xray shield.
• GUIDE and CLIP prepped by rep.
• Obtain RFV access, dilate with 8F, preclose. .032 wire inserted into perclose.
• SL1 introduced over .032 wire.
• Baylis needle inserted and echo imaging performed. Transseptal puncture performed.
• Baylis needle removed. .032wire inserted. Dilator removed
• MPA advanced over the wire to pulmonary vein. LA pressure measured. Give MD Amplatz SuperStiff to shape.
• Amplatz superStiff advanced.
• MPA removed.
• Setup stabilizer.
• SL1 removed.
• PASCAL Guide sheath inserted. Asperate 45ml of blood with a 60 cc syringes than flush with 45ml of hep saline.
• Amplatz wire and dilator removed. Clip inserted.
• Set up for subsequent clips if needed.
• Vicryl used for groin closure.

BACK TABLE SETUP

Rep's will need (2) 60 mL syringes, (1) 10 mL syringe, a large and small bowl.

All equipment prepped by reps.