TAVI - Sapien 3 (Edwards): Difference between revisions

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'''Transcatheter Aortic Valve Repair''' ([[wikipedia:Percutaneous_aortic_valve_replacement|Wikipedia]]) procedures utilize a femoral approach to deliver a stent-based aortic valve to the patients heart. There are two valve types available:
'''Transcatheter Aortic Valve Repair''' ([[wikipedia:Percutaneous_aortic_valve_replacement|Wikipedia]])  


*[https://www.medtronic.com/us-en/healthcare-professionals/therapies-procedures/cardiovascular/transcatheter-aortic-valve-replacement.html CoreValve by Medtronic] - [[TAVR - CoreValve (Medtronic)|CoreValve Procedure Page]]
*[https://www.medtronic.com/us-en/healthcare-professionals/therapies-procedures/cardiovascular/transcatheter-aortic-valve-replacement.html CoreValve by Medtronic] - [[TAVR - CoreValve (Medtronic)|CoreValve Procedure Page]]
*[https://www.edwards.com/gb/devices/heart-valves/transcatheter-SAPIEN-3-Ultra Sapien 3 Ultra by Edwards] - This page
*[https://www.edwards.com/gb/devices/heart-valves/transcatheter-SAPIEN-3-Ultra Sapien 3 Ultra by Edwards]  


This procedure is usually done in Room 1, and requires a 5 person team: Front table scrub, Back table scrub (device prep), Circulator, Pacer/Circulator, and Recorder. The rep for the respective company will be present to assist with device prep except in the case of an emergency valve placement.
==Daniels ==
 
In rare cases, the [[BASILICA]] procedure will be necessary to split the existing valve leaflets to prevent blockage of the coronary arteries. In that situation, the equipment on the [[BASILICA]] page will be needed in addition to the equipment listed below.
 
Per Rosalie:
 
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).
#Medtronic Core Valve – all items are charge separately.  Scan all barcodes (delivery system, loading system and valve).
 
MITRAL CLIP (Mitral/Tricuspid):
 
#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.
 
==Daniels/Spies - Draft==
ACIST A1000V SYRINGE USED WITH 50/50 CONTRAST MIX
ACIST A1000V SYRINGE USED WITH 50/50 CONTRAST MIX


=== **If the patient has an existing RBBB, prep the right chest and no rampart.*** ===


'''***''' '''Procedural variance as of 2/20 for DD ONLY'''***
===Equipment: ===
 
*8F dilator opened instead of sheath set.
 
*9F sheath opened
 
*ONE preclose then 150 J wire
*9F sheath inserted for valve crossing.
*Valve opened upon sheath insertion. Final crimp still performed after Amplatz ES across valve.
*9F exchanged for ESheath just prior to valve insertion.
 
 
===For coronary protection:===
 
*Radial access OR 12F dryseal in LFA if using sentinel
*6F JL4
*Runthrough
*coronary balloon on md request <br />
 
===Sheaths:===


*5Fr Micropunture  Kit  
*5Fr Micropunture  Kit  
*6Fr x 10cm sheath
*7Fr Glidesheath (2.5 Verapamil)
*8Fr x 10 cm sheath (Dilator used only)
*8Fr x 10 cm sheath
*8Fr x 35 cm Brite Tip Sheath
 
===Wires===


*(2) Cordis 150J
*(2) Cordis 150J
*Cordis 260J
*Cordis 260J
*Amplatz Extra Stiff 260cm
*1.5mm J Glidewire (BABY J glide ; ADVANCED WITH A CHEATER without catheter loaded)
*Terumo Stiff Straight Glidewire 0.035 x 150 cm
*Terumo Stiff Straight Glidewire 0.035 x 150 cm
{{Protip|</BR>For cases where patient has an LVAD you'll need a Safari II instead of an ES</BR>
*Safari  
For patients with AI you don't need the Glidewire.}}
*.035 Standard Straight for Valve-in-Valve crossing, no need for glidewire.
 
*Acist hand control
===Catheters:===
*(2) Perclose
*TR Band
*A extension line from anesthesia (Venous extension only if we are doing bipolar pacing)
*5Fr AL1 diagnostic 
*(1) 5Fr Ang Pigtail
*(1) 5Fr St. Pigtail for root angio from radial
**'''Valve-in-valve: Mosaic needs pigtail, all others do not.'''
*6Fr JL4/JR4 (when doing coronary angiography)
*Exofin topical adhesive
*NuKnit for closure
*Alligator Clip Remington Pacing Cables
* TZ Medical Defibrillation Pads -  Large pad utilized as a grounding pad on the patients left ribs.


*5Fr AL1 diagnostic 
===Standby Equipment:===
*5Fr Ang Pigtail (2 for Spies)
* 125cm 5Fr Pigtail
*5Fr JL4/JR4 (when doing coronary angiography)
* 85cm RTP
{{Protip|For AI cases you'll need a second pigtail and no AL1.}}
* 200cm Glide Advantage
* 8mm x 40mm x 200mm RX MetaCross balloon


===Medications on table:===
{{Protip|For patients with AI you don't need the Glidewire or AL1. Use second pigtail to cross. }}


=== Medications on table: ===
*Lido/Bupivicaine 50/50
*Lido/Bupivicaine 50/50


*Epinephrine 10mcg/ml in red medallion syringe (From anesthesia)
*Epinephrine 10mcg/ml in red medallion syringe (From anesthesia)
*10 ml Rotaglide
*10 ml Rotaglide yellow syringe
 
===Miscellaneous Supplies===
 
*Acist hand control
*(3) Perclose
*A & V extension line from anesthesia


===Edwards:===
===Edwards:===
Line 82: Line 53:
*Crimper
*Crimper
*Indeflator
*Indeflator
**23-26 - 2530 for up to 26+2
**29 - 38
*Appropriate delivery system and valve
*Appropriate delivery system and valve
=== Transvenous pacemaker supplies ===
*5Fr Josephson Pacing catheter
*Dual Red/Black Pacing Remington cables
*EP Quad Cable


===Standby ECMO & Pericardial Effusion supplies===
===Standby ECMO & Pericardial Effusion supplies===


==Procedure==
=== Sentinel: ===
'''''SEE BELOW FOR STEPS SPECIFIC TO SPIES and AGRAWAL'''''
* Grandslam 300cm
* 5/6 Slender
* 2.5 Verapamil
* DSA at 6fps of aortic arch with contralateral pigtail
* Don't open sentinel until we see the Grandslam advanced to the arch
* Prep instructions in lab 1 on the wall next to the light switches


=== For coronary protection: ===
*Radial access OR 12F dryseal in LFA if using sentinel
*6F JL4
*Runthrough
*coronary balloon on md request


Patient on defib pads.  IF PATIENT HAS ICD: DEVICE DISABLED FOR PROCEDURE, COMPANY REP PRESENT IF POSSIBLE.
*22G Grey Lido needle for Spies
 
Leg strap secured above knees. Wrists restrained.
 
Patient prepped from naval to mid thigh using chlorahexidine soap followed by chloraprep with 3 minute dry time.
 
Towel off site. Extend Femoral drape all the way to chin.
 
Fluoro cover used to drape anesthesia's IV pole/x-ray shield.
 
Extension tubing for anesthesia flushed and secured on respecitve sides of the groin .
 
Dual pressure lines primed and zeroed prior to case start.
 
 
'''FRONT TABLE'''
 
50/50 Lido and Bupivicaine mix used for local anesthetic.  Have extra available on front table.
 
100% contrast available on table.  (May need for hand injection or for peripheral balloon prep)
 
10ml of Rotoglide on table (Attached to E sheath with a 20ml flush of hep saline)
 
10ml syringe of Epi taped on table.
 
U/S guidance for groin access
 
 
'''BACK TABLE'''- valve prep


==Procedure==
'''''SEE BELOW FOR STEPS SPECIFIC TO SPIES and AGRAWAL and GROVES'''''


4 Bowls: (2) Normal Saline (1) Hep Saline (1) 30ml contrast, 170ml Hep Saline mix (15%)
* Patient on defib pads.  IF PATIENT HAS ICD: DEVICE DISABLED FOR PROCEDURE, COMPANY REP PRESENT IF POSSIBLE.


60ml Syringe with contrast mixture for balloon prep
* Leg strap secured above knees. Left wrist.
* Patient prepped from naval to mid thigh using chlorahexidine soap followed by chloraprep with 3 minute dry time.
* Right radial prepped.
* Towel off site. Extend Femoral drape all the way to chin.
* Extension tubing for anesthesia flushed and secured on respecitve sides of the groin .


20ml Syringe for flushing delivery system
===FRONT TABLE===


Indeflator: volume dependent upon valve size
* 50/50 Lido and Bupivacaine mix used for local anesthetic.  Have extra available on front table.
* 1-1.5 L of Hep Saline in large bowl
* 10ml of Rotaglide on table (Attached to E sheath)
* 10ml syringe of Epi on table.
* Lido with EPI.
* U/S guidance for groin access


Crimper
===BACK TABLE (Valve)===


Hemostats and scissors for valve opening
* 3 Bowls: (1) Normal Saline (500ml in each bowl)  (1) Hep Saline (500ml) (1) 15ml contrast (85ml Hep Saline added to by scrub person to make it 15%)
* 20 ml of contrast in cup (100% contrast available on table. May need for hand injection or for peripheral balloon prep)
* 60ml Syringe with contrast mixture for balloon prep.
* 20ml Syringe for flushing delivery system
* Indeflator: volume dependent upon valve size
* Crimper
* High pressure stopcock


'''PROCEDURE STEPS'''
===PROCEDURE STEPS===


*Contralateral arterial access - 6fr. Sheath (normally LFA) using micropuncture. Verify wire position with fluoro and save an image.
*Right radial access for 6Fr slender. 2.5 of verapamil.  
*Primary access - with micropuncture.  Verify wire position with fluoro and save an image
*Primary access - with micropuncture.  Verify wire position with fluoro and save an image
**Leave micropuncture wire in while venous access is obtained
**Pre-close x 1, sutures secured with hemostat.
**Once venous sheath is in place, dilate tract with 8F dilator
**8F sheath reconstituted and advanced after pre-closure.
**Pre-close x 1, sutures secured with hemostat.  
*1.5mm Baby J glidewire with cheater advanced from the radial. DO NOT preload pigtail.
**8F sheath reconstituted and advanced after pre-closure.  
 
*Venous access- 8F 35cm brite tip over 150cm J wire. (Same side as TAVR sheath)
*Pigtail -> LFA -> AO root injection
**Standard Injector settings (adjusted based on pt and root size)


10/10 20mm valve, 15/15 23mm and 26mm valve, 20/20 29mm valve
*Straight Pigtail -> AO root injection
**Standard Injector settings '''10/10 20mm valve, 15/15 23mm and 26mm valve, 20/20 29mm valve'''


*Insert and test pacemaker
**Rapid pace 160, check for capture, 220 burst
*AL1 advanced through 8F sheath over standard J.
*AL1 advanced through 8F sheath over standard J.
*Standard J removed and crossing wire advanced. Cross valve. Wire removed.
*Standard J removed and crossing wire advanced. Cross valve. Wire removed.
*Measure gradient...maybe
*Measure EDP and gradient.
*Amplatz ES shaped by MD and advanced to LV. AL1 removed.
**8fr. Dilator or micropuncture sheath on Amplatz ES as a cheater
*8F sheath removed and E Sheath advanced.
*8F sheath removed and E Sheath advanced.
*Insert valve delivery system
*Insert valve delivery system
*Test pacer, black alligator clip on back of wire.
*'''Pacing : Unipolar Pacing - pace 120 - 180 , V max output 20ma. "Dial up to 180, dial down to 120, per MD request"'''
*'''Pacing : Bipolar pacing - pace 160 with 220 burst , A max output 25ma, set RAP to 220.'''
*Multiple AO grams for positioning
*Multiple AO grams for positioning
*Pace -> AO gram ->  Pigtail pulled back -> Deploy valve
*Pace -> AO gram --> Deploy valve
**Cine length set at 40 seconds or more
**Cine length set at 40 seconds or more
*TTE
*TTE
Line 173: Line 131:
Rep will come up and re-prep valve, adding desired amount of additional volume
Rep will come up and re-prep valve, adding desired amount of additional volume


If Amplatz ES was pulled back, recross wire will be needed (260cm angled stiff glide)
If Safari was pulled back, recross wire will be needed (260cm angled stiff glide)


*Pigtail readvanced to AO for AO gram (15/30 standard injection)
*Pigtail readvanced to AO for AO gram (15/30 standard injection)
*Amplatz ES exchanged for 260 J
*Safari exchanged for 260 J
*Temp pacer removed
*Delivery system removed
*Delivery system removed
**Have second perclose, tools and dilator ready
**Have second perclose, tools and dilator ready
*Protamine given, Preclosures completed, manual pressure for 5ish minutes
*Protamine given, Preclosures completed, manual pressure for 5ish minutes
*Pigtail pulled back to iliac bifurcation and subtracted iliac angio performed...maybe
*Pigtail advanced to iliac bifurcation and subtracted iliac angio performed (6/18 on Acist)
*Pigtail removed
*Pigtail removed
*Secondary access Perclosed
*Secondary access Perclose with Nu-Knit pieces.
*Venous sheath removed in lab and manual pressure held until hemostasis achieved.  
*Lido with EPI for fem access.
*Dermabond all access sites, no dressing needed.  
*TR Band on radial.  
*Exofin all access sites, no dressing needed.
 
== THE SPIES TAVR EXPERIENCE ==
 
===Equipment:===
 
* 5Fr Micropunture  Kit  
* 6Fr Glidesheath (2.5 Verapamil)
* 8Fr x 10 cm sheath
* (2) Cordis 150J
* Cordis 260J
* Straight steel .035 wire (NO straight stiff glide)
* 1.5mm J Glidewire (BABY J glide ; ADVANCED WITH A CHEATER without catheter loaded)
* Safari
* Amplatz ES for sheath advancement
* hand control
* (2) Perclose
* TR Band
* A-extension line from anesthesia
* 5Fr AL1 diagnostic 
* (1) 5Fr Ang Pigtail
* (1) 5Fr St. Pigtail for root angio from radial
* 6Fr JL4/JR4 (when doing coronary angiography)
* Exofin topical adhesive
* Alligator Clip Remington Pacing Cables
* TZ Medical Defibrillation Pads -  Large pad utilized as a grounding pad on the patients left ribs.  


===Standby Equipment:===


===''THE SPIES TAVR EXPERIENCE''===
* 125cm 5Fr Pigtail
* 85cm RTP
* 200cm Glide Advantage
* 8mm x 40mm x 200mm RX MetaCross balloon


*All accesses obtained with micropuncture
===Procedural Differences===
*50/50 contrast for groin shot at both arterial access sites
*E Sheath in right after pre-closure over Supracore
*Amplatz ES removed after E sheath insertion. AL1 advanced with J wire backloaded.
*AL1 advanced with J wire backloaded.
*After valve crossing, EXCHANGE J inserted, AL1 removed and SECOND PIGTAIL advanced. Amplatz ES advanced through pigtail and pigtail removed.
*After valve crossing, EXCHANGE J inserted, AL1 removed and SECOND PIGTAIL advanced.  
*NO ROTOGLIDE
*Safari advanced through pigtail and pigtail removed.
*Have IM available for iliac angiogram.
*Iliac angio 6/18ml
*Iliac angio 6/18ml
*Lido with EPI at end of case
== THE GROVES TAVI EXPERIENCE ==


<br />
=== Product Substitute ===


==='''''AGRAWAL SPECIAL'''''===
* 2 pigtails
* Amplatz ES 1CM tip for sheath advancement
* Balloon-tipped Abbott Pacer


== AGRAWAL SPECIAL ==
*All accesses with mircopuncture
*All accesses with mircopuncture
*2 Percloses on primary access site
*2 Percloses on primary access site
*.035 Standard Straight wire for valve crossing
*.035 Standard Straight wire for valve crossing
*After valve crossing, EXCHANGE J inserted, AL1 removed and SECOND PIGTAIL advanced. Amplatz ES advanced through pigtail and pigtail removed.
*After valve crossing, EXCHANGE J inserted, AL1 removed and SECOND PIGTAIL advanced. Amplatz ES advanced through pigtail and pigtail removed.
*Amplatz ES to exchange 8F for E sheath
*Amplatz ES to exchange 8F for E sheath<br />
 
 
 
 
===PERIPHERAL BAILOUT EQUIPMENT===
''Have everything available in the room, but verify items prior to opening.''
 
5F Rim Catheter
 
6F or 7F Destination RDC
 
Exchange length Glidewire advantage
 
Exchange length angled glidewire


Supracore wire


Mustang balloons on 75cm shaft (6mm to 10mm x 40mm)
==PERIPHERAL BAILOUT EQUIPMENT==


Viabahn stents
* ''Have everything available in the room, but verify items prior to opening.''
<br />
* 5F Rim Catheter
===EMERGENT PERICARDIOCENTESIS===
* 6F or 7F Destination RDC
{{Pericardiocentesis}}
* Exchange length Glidewire advantage
* Exchange length angled glidewire
* Supracore wire
* Mustang balloons on 75cm shaft (6mm to 10mm x 40mm)
* Viabahn stents <br />


<br />
<hr />
Approved: MM/YY
[[Category:Procedures]]
[[Category:Procedures]]

Latest revision as of 18:14, 20 February 2025

Transcatheter Aortic Valve Repair (Wikipedia)

Daniels

ACIST A1000V SYRINGE USED WITH 50/50 CONTRAST MIX

**If the patient has an existing RBBB, prep the right chest and no rampart.***

Equipment:

  • 5Fr Micropunture  Kit  
  • 7Fr Glidesheath (2.5 Verapamil)
  • 8Fr x 10 cm sheath
  • (2) Cordis 150J
  • Cordis 260J
  • 1.5mm J Glidewire (BABY J glide ; ADVANCED WITH A CHEATER without catheter loaded)
  • Terumo Stiff Straight Glidewire 0.035 x 150 cm
  • Safari
  • .035 Standard Straight for Valve-in-Valve crossing, no need for glidewire.
  • Acist hand control
  • (2) Perclose
  • TR Band
  • A extension line from anesthesia (Venous extension only if we are doing bipolar pacing)
  • 5Fr AL1 diagnostic 
  • (1) 5Fr Ang Pigtail
  • (1) 5Fr St. Pigtail for root angio from radial
    • Valve-in-valve: Mosaic needs pigtail, all others do not.
  • 6Fr JL4/JR4 (when doing coronary angiography)
  • Exofin topical adhesive
  • NuKnit for closure
  • Alligator Clip Remington Pacing Cables
  • TZ Medical Defibrillation Pads - Large pad utilized as a grounding pad on the patients left ribs.

Standby Equipment:

  • 125cm 5Fr Pigtail
  • 85cm RTP
  • 200cm Glide Advantage
  • 8mm x 40mm x 200mm RX MetaCross balloon

Note Protip: For patients with AI you don't need the Glidewire or AL1. Use second pigtail to cross.

Medications on table:

  • Lido/Bupivicaine 50/50
  • Epinephrine 10mcg/ml in red medallion syringe (From anesthesia)
  • 10 ml Rotaglide yellow syringe

Edwards:

  • Crimper
  • Indeflator
  • Appropriate delivery system and valve

Standby ECMO & Pericardial Effusion supplies

Sentinel:

  • Grandslam 300cm
  • 5/6 Slender
  • 2.5 Verapamil
  • DSA at 6fps of aortic arch with contralateral pigtail
  • Don't open sentinel until we see the Grandslam advanced to the arch
  • Prep instructions in lab 1 on the wall next to the light switches

For coronary protection:

  • Radial access OR 12F dryseal in LFA if using sentinel
  • 6F JL4
  • Runthrough
  • coronary balloon on md request
  • 22G Grey Lido needle for Spies

Procedure

SEE BELOW FOR STEPS SPECIFIC TO SPIES and AGRAWAL and GROVES

  • Patient on defib pads. IF PATIENT HAS ICD: DEVICE DISABLED FOR PROCEDURE, COMPANY REP PRESENT IF POSSIBLE.
  • Leg strap secured above knees. Left wrist.
  • Patient prepped from naval to mid thigh using chlorahexidine soap followed by chloraprep with 3 minute dry time.
  • Right radial prepped.
  • Towel off site. Extend Femoral drape all the way to chin.
  • Extension tubing for anesthesia flushed and secured on respecitve sides of the groin .

FRONT TABLE

  • 50/50 Lido and Bupivacaine mix used for local anesthetic. Have extra available on front table.
  • 1-1.5 L of Hep Saline in large bowl
  • 10ml of Rotaglide on table (Attached to E sheath)
  • 10ml syringe of Epi on table.
  • Lido with EPI.
  • U/S guidance for groin access

BACK TABLE (Valve)

  • 3 Bowls: (1) Normal Saline (500ml in each bowl) (1) Hep Saline (500ml) (1) 15ml contrast (85ml Hep Saline added to by scrub person to make it 15%)
  • 20 ml of contrast in cup (100% contrast available on table. May need for hand injection or for peripheral balloon prep)
  • 60ml Syringe with contrast mixture for balloon prep.
  • 20ml Syringe for flushing delivery system
  • Indeflator: volume dependent upon valve size
  • Crimper
  • High pressure stopcock

PROCEDURE STEPS

  • Right radial access for 6Fr slender. 2.5 of verapamil.
  • Primary access - with micropuncture. Verify wire position with fluoro and save an image
    • Pre-close x 1, sutures secured with hemostat.
    • 8F sheath reconstituted and advanced after pre-closure.
  • 1.5mm Baby J glidewire with cheater advanced from the radial. DO NOT preload pigtail.
  • Straight Pigtail -> AO root injection
    • Standard Injector settings 10/10 20mm valve, 15/15 23mm and 26mm valve, 20/20 29mm valve
  • AL1 advanced through 8F sheath over standard J.
  • Standard J removed and crossing wire advanced. Cross valve. Wire removed.
  • Measure EDP and gradient.
  • 8F sheath removed and E Sheath advanced.
  • Insert valve delivery system
  • Test pacer, black alligator clip on back of wire.
  • Pacing : Unipolar Pacing - pace 120 - 180 , V max output 20ma. "Dial up to 180, dial down to 120, per MD request"
  • Pacing : Bipolar pacing - pace 160 with 220 burst , A max output 25ma, set RAP to 220.
  • Multiple AO grams for positioning
  • Pace -> AO gram --> Deploy valve
    • Cine length set at 40 seconds or more
  • TTE

if post dilation is needed...

Rep will come up and re-prep valve, adding desired amount of additional volume

If Safari was pulled back, recross wire will be needed (260cm angled stiff glide)

  • Pigtail readvanced to AO for AO gram (15/30 standard injection)
  • Safari exchanged for 260 J
  • Delivery system removed
    • Have second perclose, tools and dilator ready
  • Protamine given, Preclosures completed, manual pressure for 5ish minutes
  • Pigtail advanced to iliac bifurcation and subtracted iliac angio performed (6/18 on Acist)
  • Pigtail removed
  • Secondary access Perclose with Nu-Knit pieces.
  • Lido with EPI for fem access.
  • TR Band on radial.
  • Exofin all access sites, no dressing needed.

THE SPIES TAVR EXPERIENCE

Equipment:

  • 5Fr Micropunture  Kit  
  • 6Fr Glidesheath (2.5 Verapamil)
  • 8Fr x 10 cm sheath
  • (2) Cordis 150J
  • Cordis 260J
  • Straight steel .035 wire (NO straight stiff glide)
  • 1.5mm J Glidewire (BABY J glide ; ADVANCED WITH A CHEATER without catheter loaded)
  • Safari
  • Amplatz ES for sheath advancement
  • hand control
  • (2) Perclose
  • TR Band
  • A-extension line from anesthesia
  • 5Fr AL1 diagnostic 
  • (1) 5Fr Ang Pigtail
  • (1) 5Fr St. Pigtail for root angio from radial
  • 6Fr JL4/JR4 (when doing coronary angiography)
  • Exofin topical adhesive
  • Alligator Clip Remington Pacing Cables
  • TZ Medical Defibrillation Pads - Large pad utilized as a grounding pad on the patients left ribs.

Standby Equipment:

  • 125cm 5Fr Pigtail
  • 85cm RTP
  • 200cm Glide Advantage
  • 8mm x 40mm x 200mm RX MetaCross balloon

Procedural Differences

  • E Sheath in right after pre-closure over Supracore
  • AL1 advanced with J wire backloaded.
  • After valve crossing, EXCHANGE J inserted, AL1 removed and SECOND PIGTAIL advanced.
  • Safari advanced through pigtail and pigtail removed.
  • Iliac angio 6/18ml
  • Lido with EPI at end of case

THE GROVES TAVI EXPERIENCE

Product Substitute

  • 2 pigtails
  • Amplatz ES 1CM tip for sheath advancement
  • Balloon-tipped Abbott Pacer

AGRAWAL SPECIAL

  • All accesses with mircopuncture
  • 2 Percloses on primary access site
  • .035 Standard Straight wire for valve crossing
  • After valve crossing, EXCHANGE J inserted, AL1 removed and SECOND PIGTAIL advanced. Amplatz ES advanced through pigtail and pigtail removed.
  • Amplatz ES to exchange 8F for E sheath


PERIPHERAL BAILOUT EQUIPMENT

  • Have everything available in the room, but verify items prior to opening.
  • 5F Rim Catheter
  • 6F or 7F Destination RDC
  • Exchange length Glidewire advantage
  • Exchange length angled glidewire
  • Supracore wire
  • Mustang balloons on 75cm shaft (6mm to 10mm x 40mm)
  • Viabahn stents
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