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'''TransCatheter Mitral Valve Repair/Replacement'''
{{Protip|Need Alcohol in lab for this procedure!}}
 
'''TransCatheter Mitral Valve Insertion'''


Per Rosalie:
Per Rosalie:


TAVR/TMVI
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 charged separately.  Scan all barcodes (delivery system, loading system and valve).


MITRAL CLIP (Mitral/Tricuspid):
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.
#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.
{| class="wikitable"
|+
! colspan="4" |TMVR
|-
!Anesthesia
!Imaging
!Access
!Pre-Procedure
|-
|
* General Anesthesia


* A-Line Always!
|
* Single Plane Fluoro


'''GENERAL ANESTHESIA AND TEE IMAGING, RADIAL ART LINE BY ANESTHESIA'''
* TEE


'''ACCESS 2 FEMORAL VEINS (TAVR AND PACER)'''
* No Acist
* Unipolar pacing
|


'''PRE PROCEDURE: TYPE AND CROSS, ASPIRIN GIVEN'''
* RVF pre-closed x 1
|
* Type and Cross


==SHEATHS:==
* Aspirin Given
|}
==Open:==
===Sheaths:===


*Micropuncture
*Micropuncture
*8fr Pinnacle for Perclose
*8fr Pinnacle for Perclose
*8x35 Brite tip
*Perclose (If Spies is primary, NO perclose if Daniels is primary.)
*8.5F SL1
*8.5F Agilis
*8.5F Tourguide
*16F E sheath, '''always''', regardless of valve size.
*16F E sheath, always, regardless of valve size.
==WIRES:==
 
===Open===


=== Wires: ===
*150 J wire
*150 J wire
*.'''032''' x 260 J-wire
*Safari 2
*Safari 2
*Amplatz Super Stiff 1cm tip


==CATHETERS==
===Baylis:===
* VersaCross system
* Grounding pad


===Open===
=== Misc: ===
*Naked 3 Port Manifold
*Alligator pacing cable


=== Catheters: ===
*6fr. Straight Pig
*6fr. Straight Pig
*5fr. MPA2
*Naked 3 Port Manifold
==PACING==
*5F Josephson Pacing Cable
*EP Quad Cable
*Remington Pacing Cable
*(2) Pacer Boxes
*
==FOR EDWARDS VALVE==


*INDEFLATOR
=== Septal dilation: ===
*CRIMPER
*'''12X4X75 Mustang for 23mm and 26mm Sapien or 14mm Armada for 29mm Sapien'''
*E SHEATH
*Presto indeflator
*DELIVERY SYSTEM
*VALVE


==TRANS SEPTAL==
===Edwards valve:===
*Indeflator (Second Indeflator on standby)
*Crimper
*E-sheath (Second E-Sheath on standby)
*Delivery system (Second delivery on standby)
*Valve


*BAYLIS NEEDLE LARGE CURVE C1
== Balloon Valve Fracture ==
*BAYLIS MACHINE
[[File:Valve_Cracker.jpg|thumb|150px|right|Valve Cracker Setup|link={{filepath:Valve_Cracker.jpg}}]]
*BAYLIS CABLE
[[Double Pump Valve Cracker]]
*GROUNDING PAD
===Equipment===


==SEPTAL DILATION==
* Atrion 38 indeflator
* Atrion 25 indeflator
* 4-way stopcock
* True Balloon (1mm smaller than intended Sapien implant)
** Fill big indeflator '''all the way''', 20ml in small indeflator


===Open===
===Procedure===


*12X4X75 MUSTANG '''for 23mm and 26mm sapien''' 14mm Armada '''for 29mm sapien'''
# Use TAVR mix
*PRESTO INDEFLATOR
# De-air and fill both indeflators
# Prep balloon similar to Edwards Delivery system prep
# Attach both indeflators and open stopcock to be open all ways
# Lock both indeflators


===Standby===
==Standby:==


*9X4X75 MUSTANG
===Septal procedure:===
*9X4X75 Mustang
*14, 16 XXL Balloons
*14, 16 XXL Balloons
*TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
*Torqueview 45° delivery system (9fr. or 10fr.)
*10MM, 14MM, 18MM SEPTAL OCCLUDER
*10mm, 14mm, 18mm septal occluder


==ADDITIONAL SUPPLIES==
===Baylis Standby===
*SL1 sheath
*Large curve Baylis needle
*Baylis cable
*0.32 x 260 J-wire


===Open===
===Bipolar pacing standby:===
 
*8x35 Brite tip
*2xPERCLOSE
*5F Josephson Pacing Cable
*3 PORT MANIFOLD - No contrast
*EP Quad Cable
*PROBE COVER
*Remington Pacing Cable
*CHLORAPREP AND PREP TRAY
*(2) Pacer Boxes
 
===Standby===
 
*150ML CONTRAST (FOR CORONARIES)
*BIOPATCH
*8F ANGIOSEAL
*0 SILK SUTURE
*EXTRA PERCLOSE
 
==MEDICATIONS==
 
*BUPIVACAINE
*EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE
*ROTAGLIDE 10ML (EDWARDS VALVE)
 
==STANDBY EMERGENCY ECMO SUPPLIES==


*16F ARTERIAL CANNULA
*21F VENOUS CANNULA
*(2) PERCLOSE
*ECMO INSTRUMENT TRAY
*AMPLATZ SUPER STIFF


==STANDBY PERICARDIOCENTESIS SUPPLIES==
==Medications for table==


*EYE DRAPE
*Bupivacaine/Lidocaine
*CHIBA NEEDLE 10CM 18G
*Epinephrine 10mcg/ml in red syringe on back table secured with steri-strip
*SKATER INTRODUCER SET
*Rotaglide 10 ml (Edwards valve only!)
*BARD LOCKING PIGTAIL 6F OR 8F
*(3) 60ML SYRINGES
*STOPCOCK
*AMPLATZ SUPER STIFF 180CM


==PROCEDURE:==
==Procedure:==


*Patient prepped from '''navel to knees''' in sterile fashion.  
*Patient prepped from '''navel to knees''' in sterile fashion.  
*Access obtained with u/s
*Access obtained with u/s
*Dilate with 8F dilator
*Pre-close, Versacross pigtail wire advanced through Perclose
*Versacross sheath inserted
*Transeptal puncture, then pigtail wire advanced
*Versacross sheath removed
*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.
*Perclose completed and stitch to RFV
*Dermabond access site, no dressings needed.


Typical sites:  
==ECMO Standby:==
*16fr. vented arterial cannula
*21fr. venous cannula
*Perclose x 2
*ECMO instrument tray
*180 Amplatz Super Stiff wire


14F OR 16F RFV E-sheath for valve delivery
==Pericardiocentesis standby==
*Eye drape
*18g. x 10 cm. Chiba needle
*Skater introducer set
*Bard locking pigtail 6fr. or 8fr.
*60ml syringe x 3
*Stopcock
*180 Amplatz Super Stiff wire


****Dilate with 8F
****Preclose x 2.
*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, .032 wire advanced to pulmonary vein
*MP advanced to LUPV, .032 wire removed and super stiff advanced
*MP removed and tourguide advanced and directed to mitral valve
*Pigtail and Safari2 inserted through tourguide for valve crossing.
*Safari2 wire inserted to ventricle. LV pressure recorded.
*Pigtail and tourguide removed.
*12mm/14mm balloon advanced for septostomy and possible BAV
*Balloon removed, valve delivery system advanced.
*When valve is in place, temp pacer inserted and tested.
*Valve deployed. Septum evaluated with echo for shunting.
*Pacer removed. Delivery system removed.
*Preclosure closed and stitch to RFV
*8F vein pulled and manual pressure applied
*Dermabond access site, no dressings needed.


<br>
[[Category:Procedures]]
[[Category:Procedures]]
[[Category:NeedsWork]]
 
<HR />
<HR />
APPROVED: MD initials MM/YY
APPROVED: MD initials MM/YY

Latest revision as of 18:26, 12 March 2025

Note Protip: Need Alcohol in lab for this procedure!

TransCatheter Mitral Valve Insertion

Per Rosalie:

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 charged 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 Always!
  • 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 Daniels is primary.)
  • 8.5F Agilis
  • 16F E sheath, always, regardless of valve size.

Wires:

  • 150 J wire
  • Safari 2

Baylis:

  • VersaCross system
  • Grounding pad

Misc:

  • Naked 3 Port Manifold
  • Alligator pacing cable

Catheters:

  • 6fr. Straight Pig

Septal dilation:

  • 12X4X75 Mustang for 23mm and 26mm Sapien or 14mm Armada for 29mm Sapien
  • Presto indeflator

Edwards valve:

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

Balloon Valve Fracture

Valve Cracker Setup

Double Pump Valve Cracker

Equipment

  • Atrion 38 indeflator
  • Atrion 25 indeflator
  • 4-way stopcock
  • True Balloon (1mm smaller than intended Sapien implant)
    • Fill big indeflator all the way, 20ml in small indeflator

Procedure

  1. Use TAVR mix
  2. De-air and fill both indeflators
  3. Prep balloon similar to Edwards Delivery system prep
  4. Attach both indeflators and open stopcock to be open all ways
  5. Lock both indeflators

Standby:

Septal procedure:

  • 9X4X75 Mustang
  • 14, 16 XXL Balloons
  • Torqueview 45° delivery system (9fr. or 10fr.)
  • 10mm, 14mm, 18mm septal occluder

Baylis Standby

  • SL1 sheath
  • Large curve Baylis needle
  • Baylis cable
  • 0.32 x 260 J-wire

Bipolar pacing standby:

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


Medications for table

  • Bupivacaine/Lidocaine
  • Epinephrine 10mcg/ml in red syringe on back table secured with steri-strip
  • Rotaglide 10 ml (Edwards valve only!)

Procedure:

  • Patient prepped from navel to knees in sterile fashion.  
  • Access obtained with u/s
  • Dilate with 8F dilator
  • Pre-close, Versacross pigtail wire advanced through Perclose
  • Versacross sheath inserted
  • Transeptal puncture, then pigtail wire advanced
  • Versacross sheath removed
  • 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.
  • Perclose completed and stitch to RFV
  • Dermabond access site, no dressings needed.


ECMO Standby:

  • 16fr. vented arterial cannula
  • 21fr. venous cannula
  • Perclose x 2
  • ECMO instrument tray
  • 180 Amplatz Super Stiff wire

Pericardiocentesis standby

  • Eye drape
  • 18g. x 10 cm. Chiba needle
  • Skater introducer set
  • Bard locking pigtail 6fr. or 8fr.
  • 60ml syringe x 3
  • Stopcock
  • 180 Amplatz Super Stiff wire

APPROVED: MD initials MM/YY

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