Open MVI: Difference between revisions
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Hybrid OR Procedure | Hybrid OR Procedure | ||
< | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588478/ | ||
[[File:MVRskirt.jpeg|thumb|150px|right|Gore-Tex skirt on valve<BR> | |||
*7-0 Prolene<BR> | |||
*.04 Gore-tex]] | |||
==Supplies== | |||
===Open=== | |||
*TAVR pack | |||
*Certitude system | |||
*Crimper | |||
*29 valve | |||
*38 indeflator | |||
*Safari wire | |||
*2x Perclose | |||
*8fr Pinnacle sheath | |||
*Micropuncture | |||
{{Note|OR supplies cannula and Amplatz SS wires. Dave doesn’t like their micropuncture}} | |||
===Standby=== | |||
*Sentinel | |||
===Bring=== | |||
*TAVI cart | |||
*CL to-go cart | |||
*Small cath table | |||
*Very small utility table | |||
*2 CL staff needed- 1 scrub 1 circulator/monitor | *2 CL staff needed- 1 scrub 1 circulator/monitor | ||
*Leave carts in the hall | *Leave carts in the hall | ||
*small cath table and small utility table in room for valve prep | |||
*IF Sentinel: | *IF Sentinel: | ||
**Surgical incision made first so anticoagulation can be performed after | **Surgical incision made first so anticoagulation can be performed after | ||
**Preprep device | **Preprep device | ||
**Keep ACIST on cart and have ready to hook up, 100% contrast ok if creatnine ok | **Keep ACIST on cart and have ready to hook up, 100% contrast ok if creatnine ok | ||
*IF CP Bypass cannulas inserted by IC | *IF CP Bypass cannulas inserted by IC | ||
**8F sheath first used for pigtail- AOgram for sentinel | **8F sheath first used for pigtail- AOgram for sentinel | ||
| Line 18: | Line 47: | ||
*Don't open valve equipment until cannulas and sentinel in place (if using) | *Don't open valve equipment until cannulas and sentinel in place (if using) | ||
*Remove C arm after sentinel/cannula placement. | *Remove C arm after sentinel/cannula placement. | ||
*Remove Sentinel BEFORE PROTAMINE | *Remove Sentinel BEFORE PROTAMINE | ||
==Setup== | |||
*Arrange valve prep equipment on cath table | |||
*Fluids as per usual for TAVR | |||
**1L Hep saline in medium and wire bowls | |||
**1L NACL in 2 bowls | |||
**30cc Visi in bowl | |||
*Remove all gauze and countables. Keep 18g access needle, scalpel, and instruments. | |||
==Procedure== | |||
#Setup on small cath table for valve sewing and crimping, small utility table for extra stuff | |||
#Pt. in room. A-line, swan etc. | |||
#Surgeon starts sewing valve | |||
#Prep and drape | |||
#Cardiologist inserts femoral cannulae same as ECMO. | |||
#Surgeon opens chest | |||
#When old valve is exposed, pre-crimp valve and confirm | |||
#Crimp when ready, insert Safari into Certitude, and cut wire short (~1 foot out the back of the Certitude) | |||
#Remove surgical obstructions and position valve under fluoro. | |||
#Deploy valve | |||
#Remove Certitude | |||
#Close | |||
[[Category:Procedures]] | [[Category:Procedures]] | ||
Latest revision as of 15:26, 24 January 2023
Hybrid OR Procedure
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588478/
Supplies
Open
- TAVR pack
- Certitude system
- Crimper
- 29 valve
- 38 indeflator
- Safari wire
- 2x Perclose
- 8fr Pinnacle sheath
- Micropuncture
Note: OR supplies cannula and Amplatz SS wires. Dave doesn’t like their micropuncture
Standby
- Sentinel
Bring
- TAVI cart
- CL to-go cart
- Small cath table
- Very small utility table
- 2 CL staff needed- 1 scrub 1 circulator/monitor
- Leave carts in the hall
- small cath table and small utility table in room for valve prep
- IF Sentinel:
- Surgical incision made first so anticoagulation can be performed after
- Preprep device
- Keep ACIST on cart and have ready to hook up, 100% contrast ok if creatnine ok
- IF CP Bypass cannulas inserted by IC
- 8F sheath first used for pigtail- AOgram for sentinel
- Preclose A x 2
- Standard ECMO equipment
- Don't open valve equipment until cannulas and sentinel in place (if using)
- Remove C arm after sentinel/cannula placement.
- Remove Sentinel BEFORE PROTAMINE
Setup
- Arrange valve prep equipment on cath table
- Fluids as per usual for TAVR
- 1L Hep saline in medium and wire bowls
- 1L NACL in 2 bowls
- 30cc Visi in bowl
- Remove all gauze and countables. Keep 18g access needle, scalpel, and instruments.
Procedure
- Setup on small cath table for valve sewing and crimping, small utility table for extra stuff
- Pt. in room. A-line, swan etc.
- Surgeon starts sewing valve
- Prep and drape
- Cardiologist inserts femoral cannulae same as ECMO.
- Surgeon opens chest
- When old valve is exposed, pre-crimp valve and confirm
- Crimp when ready, insert Safari into Certitude, and cut wire short (~1 foot out the back of the Certitude)
- Remove surgical obstructions and position valve under fluoro.
- Deploy valve
- Remove Certitude
- Close
