Valve in MAC with Antegrade Lampoon: Difference between revisions

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'''GENERAL ANESTHESIA AND TEE IMAGING, RADIAL ART LINE BY ANESTHESIA'''
{| class="wikitable"
! colspan="4" |Valve in MAC with Antegrade Lampoon
|-
!Anesthesia
!Imaging
!Access
!ACIST/manifold
|-
|General
L Radial art line
|Fluoro and TEE
|
*26F RFV (For transeptal equipment) (No need for E-Sheath)
*8F LFA(For IABP and Pigtial for arch shot)
*6F RRA (For Sentinel)
|
* Naked manifold


'''OVERLAY FOR SENTINEL'''
* One manifold with contrast;
|-


'''PRE PROCEDURE: TYPE AND CROSS, ASPIRIN GIVEN'''
! colspan="4" |Pre-Procedure Watchouts
|-
| colspan="4" |
PRE PROCEDURE: TYPE AND CROSS, ASPIRIN GIVEN
|-
|}




MAC- Mitral Annular Calcification
https://www.jtcvs.org/article/S0022-5223(18)31545-9/pdf
Per Rosalie:


===Per Rosalie:===
TAVR/TMVI
TAVR/TMVI
#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).
#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).
#Medtronic Core Valve – all items are charge separately.  Scan all barcodes (delivery system, loading system and valve).
#Medtronic Core Valve – all items are charge separately.  Scan all barcodes (delivery system, loading system and valve).
===Access sites:===
===Access sites:===
26F RFV (For transeptal equipment) (No need for E-Sheath)
*26F RFV (For transeptal equipment) (No need for E-Sheath)        
 
*8F LFA(For IABP and pigtail for arch shot)
8F LFV (For pacer)
*6F RRA (For Sentinel)  
 
8F LFA
(For IABP)
 
6F RFA (For JR4 Guide)
 
6F RRA (For Sentinel)  


==Supplies:==
===Open:===
===Open:===
'''FROM STRUCTURAL HEART CART'''
====FROM STRUCTURAL HEART CART====
*.014 Astato xs 20 guidewire 180cm for ALEGRA; 300cm for standard
*Piggyback wire converter 4fr x 145 (or finecross, if no Piggybacks)
*26F Dryseal
*(2) Agilis
*(2) 25mm Gooseneck snare (confirm before opening)
*14mm Armada Balloon
*VersaCross
*Bovie pen
*Grounding Pad


.014 Astato xs 20 guidewire 180cm for ALEGRA; 300cm for standard
===MISC SUPPLIES===
*(3) Watchdog devices
*(3) Stopcocks
*4 hemostats
*(3) 60ml syringes
*(2) 12 inch extension tubing
*Extra bowl for D5
*Indeflator for septostomy
*Balloon Pump
*Sentinel - opened after grandslam wire across great vessel
*Alligator cables


Piggyback wire converter 4fr x 145 (or finecross, confirm)
===FROM ROOM SUPPLIES===
 
*Micropuncture
26F Dryseal
*(2) 8F Sheath
 
*5/6 Slender Sheath
14mm Armada Balloon
*(2) Preclose
 
*TR-Band
SL1
*(2) .032 260cm J wire  
 
*.035 260cm J wire
Baylis Needle
*.035 150cm J wire
 
*300cm Grandslam
Bovie pen
*300 cm Runthrough wire
 
*Safari
Grounding Pad
*Amplatz SS 7 cm - For sheath advancement
 
*6F PA Catheter
 
*(2) 6F JR4 Guide
'''MISC SUPPLIES'''
*6F JL3.5 Guide
 
*5F MPA1
(3) Watchdog devices
*6F Straight Pigtail
 
*0-Ethibond
(3) Stopcocks
*0-Prolene on a Ct-1 Needle for Woggle
 
4 hemostats
 
(3) 60ml syringes
 
(2) 12 inch extension tubing
 
Bowl of D5
 
(2) Agilis SM Curl
 
Priority Pack
 
Balloon Pump
 
 
'''FROM STORE ROOM'''
 
8F 35cm Brite Tip Sheath
 
Josephson Pacing Wire
 
Remington Cable
 
Blue Pacing Cable
 
Sentinel- opened after grandslam wire across great vessels
 
 
'''FROM ROOM SUPPLIES'''
 
6F PA Catheter
 
260cm Angled Glidewire
 
(2) .032 260cm J wire
 
(1) .035 260cm J wire
 
(1) .035 150cm J wire
 
300cm Grandslam
 
300 cm Runthrough wire
 
Safari  
 
Amplatz SS 1cm
 
8F Sheath
 
(2) 6F JR4 Guide
 
6F JL3.5 Guide
 
5F MPA1
 
6F Straight Pigtail
 
5/6 Slender Sheath
 
25mm Gooseneck snare (Able to utilized this snare for both wire grasps)
 
Preclose x 4
 
0 Ethibond
 
0 Prolene  
 
TR-Band<br />


===Standby:===
===Standby:===
12F Flexcath
*12F Flexcath
 
*6F MP Guide
6F MP Guide
*8F 90cm Shuttle sheath and 125cm Pigtail for measuring gradient post valve placement '''Standby Items FROM STORE ROOM'''
 
**8F 35cm Brite Tip Sheath
8F 90cm Shuttle sheath and 125cm Pigtail for measuring gradient post valve placement<br />
**Josephson Pacing Wire
**Remington Cable
**Blue Pacing Cable


===Rough Procedural Plan:===
===Rough Procedural Plan:===
Obtain access as listed above.
#Obtain access as listed above.
 
#After radial access Grandslam advanced to determine if Sentinal can be utilized. Grandslam removed until all accesses are obtained.
After radial access Grandslam advanced to determine if Sentinal can be utilized. Grandslam removed until all access are obtain.  
#Preclose LFA x 1 and 8F sheath inserted for IABP
 
#Preclose RFV and dryseal inserted over super stiff wire
Preclose LFA x 1 and 8F sheath inserted for IABP
#6F Pigtail advanced for arch shot (hand injection with manifold, NO DSA) for sentinel.
 
#Grandslam and Sentinal advanced. Pigtail removed after sentinel in position.  
Preclose RFV x 2 and dryseal inserted over super stiff wire
#SL1- transeptal puncture
 
#Exchange SL1 for two .032 wires
6F Pigtail advanced for arch shot (20 for 20) for sentinel.
#Agilis x 2 inserted
 
#6F PA floated through one of the Agilis over runthrough
Grandslam and Sentinal advanced. Pigtail removed after sentinel in position.  
#6F JR4 with ensnare inserted through LFA. Runthrough snared in LV.
 
#PA catheter removed and 6F JL3.5 advanced over snared runthrough
Balloon pump advanced.
#6F JR4 through other agilis.
 
#Lampoon equipment advanced through 6F JR4
SL1- transeptal puncture
#25mm Gooseneck snare through JL3.5 next to runthrough
 
#*(if ballooning leaflet for LVOT obstruction make sure "flying-V" isn't added to wire until after 5.0 x 20 compliant balloon is utilized)
Exchange SL1 for two .032 wires
#Anterior leaflet traversed.-- Test bovie at 30 cut. Increase to 70 cut for traversal and laceration.
 
#After leaflet traversal and system snared- guide and Runthrough removed.
Agilis x 2 inserted
#Balloon pump advanced.
 
#Leaflet lacerated.
6F PA floated through one of the Agilis over runthrough
#Lampoon system deconstructed. (May need SL1, 032 wire and agilis to regain transeptal access; so quickly reprep one agilis)  
 
#Pigtail advanced with Safari
6F JR4 with ensnare inserted through LFA. Runthrough snared in LV.
#Pigtail out. Unipolar pacing tested.  
 
#Septostomy.
PA catheter removed and 6F JL3.5 advanced over snared runthrough
#Valve inserted and deployed.
 
#Pigtail for wire exchange
6F JR4 through other agilis.
#If a post deployment gradient is needed, balloon pump will be removed and short 8F sheath exchanged for 8F 90cm shuttle sheath. 125cm pigtail inserted to LV. 2nd manifold needed.
 
Lampoon equipment advanced through 6F JR4
 
25mm Gooseneck snare through JL3.5 next to runthrough
 
(if ballooning leaflet for LVOT obstruction make sure "flying-V" isn't added to wire until after 5.0 x 20 compliant balloon is utilized)
 
Anterior leaflet traversed.-- Test bovie at 30 cut. Increase to 70 cut for traversal and laceration.
 
After leaflet traversal and system snared- 7F guide and Runthrough removed.
 
Pacer inserted.
 
Leaflet lacerated.
 
Lampoon system deconstructed. (May need SL1, 032 wire and agilis to regain transeptal access; so quickly reprep one agilis)  
 
Pigtail advanced with Safari
 
Pigtail out.
 
Septostomy
 
Valve inserted and deployed.
 
Pigtail for wire exchange
 
If a post deployment gradient is needed, balloon pump will be removed and short 8F sheath exchanged for 8F 90cm shuttle sheath. 125cm pigtail inserted to LV. 2nd manifold needed.
 
 
 
 
<nowiki>*</nowiki>ECMO??


<nowiki>*</nowiki>Possible ASD Closure
*ECMO??
*Possible ASD Closure


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

Latest revision as of 13:53, 17 January 2025

Valve in MAC with Antegrade Lampoon
Anesthesia Imaging Access ACIST/manifold
General

L Radial art line

Fluoro and TEE
  • 26F RFV (For transeptal equipment) (No need for E-Sheath)
  • 8F LFA(For IABP and Pigtial for arch shot)
  • 6F RRA (For Sentinel)
  • Naked manifold
  • One manifold with contrast;
Pre-Procedure Watchouts

PRE PROCEDURE: TYPE AND CROSS, ASPIRIN GIVEN


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).

Access sites:

  • 26F RFV (For transeptal equipment) (No need for E-Sheath)
  • 8F LFA(For IABP and pigtail for arch shot)
  • 6F RRA (For Sentinel)

Supplies:

Open:

FROM STRUCTURAL HEART CART

  • .014 Astato xs 20 guidewire 180cm for ALEGRA; 300cm for standard
  • Piggyback wire converter 4fr x 145 (or finecross, if no Piggybacks)
  • 26F Dryseal
  • (2) Agilis
  • (2) 25mm Gooseneck snare (confirm before opening)
  • 14mm Armada Balloon
  • VersaCross
  • Bovie pen
  • Grounding Pad

MISC SUPPLIES

  • (3) Watchdog devices
  • (3) Stopcocks
  • 4 hemostats
  • (3) 60ml syringes
  • (2) 12 inch extension tubing
  • Extra bowl for D5
  • Indeflator for septostomy
  • Balloon Pump
  • Sentinel - opened after grandslam wire across great vessel
  • Alligator cables

FROM ROOM SUPPLIES

  • Micropuncture
  • (2) 8F Sheath
  • 5/6 Slender Sheath
  • (2) Preclose
  • TR-Band
  • (2) .032 260cm J wire
  • .035 260cm J wire
  • .035 150cm J wire
  • 300cm Grandslam
  • 300 cm Runthrough wire
  • Safari
  • Amplatz SS 7 cm - For sheath advancement
  • 6F PA Catheter
  • (2) 6F JR4 Guide
  • 6F JL3.5 Guide
  • 5F MPA1
  • 6F Straight Pigtail
  • 0-Ethibond
  • 0-Prolene on a Ct-1 Needle for Woggle

Standby:

  • 12F Flexcath
  • 6F MP Guide
  • 8F 90cm Shuttle sheath and 125cm Pigtail for measuring gradient post valve placement Standby Items FROM STORE ROOM
    • 8F 35cm Brite Tip Sheath
    • Josephson Pacing Wire
    • Remington Cable
    • Blue Pacing Cable

Rough Procedural Plan:

  1. Obtain access as listed above.
  2. After radial access Grandslam advanced to determine if Sentinal can be utilized. Grandslam removed until all accesses are obtained.
  3. Preclose LFA x 1 and 8F sheath inserted for IABP
  4. Preclose RFV and dryseal inserted over super stiff wire
  5. 6F Pigtail advanced for arch shot (hand injection with manifold, NO DSA) for sentinel.
  6. Grandslam and Sentinal advanced. Pigtail removed after sentinel in position.
  7. SL1- transeptal puncture
  8. Exchange SL1 for two .032 wires
  9. Agilis x 2 inserted
  10. 6F PA floated through one of the Agilis over runthrough
  11. 6F JR4 with ensnare inserted through LFA. Runthrough snared in LV.
  12. PA catheter removed and 6F JL3.5 advanced over snared runthrough
  13. 6F JR4 through other agilis.
  14. Lampoon equipment advanced through 6F JR4
  15. 25mm Gooseneck snare through JL3.5 next to runthrough
    • (if ballooning leaflet for LVOT obstruction make sure "flying-V" isn't added to wire until after 5.0 x 20 compliant balloon is utilized)
  16. Anterior leaflet traversed.-- Test bovie at 30 cut. Increase to 70 cut for traversal and laceration.
  17. After leaflet traversal and system snared- guide and Runthrough removed.
  18. Balloon pump advanced.
  19. Leaflet lacerated.
  20. Lampoon system deconstructed. (May need SL1, 032 wire and agilis to regain transeptal access; so quickly reprep one agilis)
  21. Pigtail advanced with Safari
  22. Pigtail out. Unipolar pacing tested.
  23. Septostomy.
  24. Valve inserted and deployed.
  25. Pigtail for wire exchange
  26. If a post deployment gradient is needed, balloon pump will be removed and short 8F sheath exchanged for 8F 90cm shuttle sheath. 125cm pigtail inserted to LV. 2nd manifold needed.
  • ECMO??
  • Possible ASD Closure
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