BASILICA: Difference between revisions

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*Dryseal exchanged for ESheath
*Dryseal exchanged for ESheath
*Do a TAVR.
*Do a TAVR.
*Test edit





Revision as of 15:58, 28 October 2019

(Bioprosthetic Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction)

ACC.org BASILICA Page

Open

  • 14frx33cm Gore Dry Seal Flex
  • 6fr MP1 guide catheter
  • .018 Platinum Plus guidewire 260 cm
  • Gooseneck Snare 20mm
  • 6 Fr PAL 1.0 (for LCA BASILICA) -OR- 6 FR MPA1 Guide (For RCA BASILICA)
  • .014 Astato xs 20 guidewire 300 cm
  • Bovie pen
    • Grounding Pad
    • Bovie machine
  • (2) Watchdog devices
  • (2) Stopcocks
  • 4 hemostats
  • (2) 60ml syringes
  • (2) 12 inch extension tubing
  • Bowl of D5

Standby

  • Gooseneck snares 25, 30mm
  • Piggyback wire converter 4fr x 145 (On standby)
  • .035 QuickCross (On standby)
  • AL2, AL3, EBU4, EBU 3.75 (Left leaflet)
  • PAR1, JR4, IM, AR1 (Right leaflet)
  • (3) .014 torque devices
  • (2) .035 torque devices
  • Finecross 135


Procedure

  • Setup and access is the same as TAVR except a 14F Dryseal sheath is inserted initially instead of the ESheath.
    • Bovie set at 30 CUT ONLY.
  • AL1 advanced over J wire through 6F sheath. Wire exchanged for straight stiff glidewire for valve crossing.
  • AL1 exchanged over the wire for MP1 Guide with watchdog and stopcock attached.
  • Platinum Plus wire is preshaped by MD and inserted through MP to retain LV access.
  • Snare advanced through MP alongside Platinum Plus.
  • BASILICA catheter advanced through Dryseal sheath with watchdog and stopcock attached.
  • Kinked Astato wire advanced through BASILICA catheter.
  • Hand injection performed to verify position of BASILICA catheter.
  • Astato wire connected to bovie with 2 hemostats.
  • RF applied as Astato wire advanced.
  • Once wire penetrates leaflet it is snared and pulled into MP1.
  • Platinum Plus wire removed
  • Pacing wire advanced and tested
  • Al1 advanced next to BASILICA catheter and valve recrossed in standard fashion.
  • 60ml D5 filled syringes and extension tubing attached to sideports of guides and injected simultaneously during leaflet laceration.
  • MP removed. BASILICA catheter removed.
  • Amplatz ES advanced through AL1 and AL1 removed.
  • Pigtail advanced to coronary cusp
  • Dryseal exchanged for ESheath
  • Do a TAVR.
  • Test edit




Approved: MM/YY