MAC Lampoon steps

1. RRA access -> 6fr slender
   • Grandslam to check access to arch
   • Grandslam removed until access is completed
2. LFA access -> 8fr dilator -> Pre-close -> 8fr. Pinnacle
3. LFV access -> 8.5fr. X 23 brite tip
4. RFV access -> 8fr dilator -> Pre-close x2 -> Amplatz Super Stiff -> 26 Dry Seal
5. 6fr pigtail through LFA for arch shot
   • 6 FPS and subtraction
6. Grandslam loaded in Sentinel and inserted
   • Pigtail removed after Sentinel deployed
7. .032x260 loaded in SL1 and advanced through Dryseal
8. Wire removed and Baylis needle advanced
9. Transseptal puncture
10. If septum is soft/thin:
    • SL1 advanced into LA
    • .032x260 x2 inserted into LA via SL1
11. If septum is thick/tough:
    • .032x260 inserted into SL1 with MPA and placed in LUPV
    • .032 exchanged for Amplatz SS 1cm
    • SL1 advanced into LA
    • Amplatz SS exchanged for .032x260 x2 inserted into LA
12. SL1 removed
13. Agilis x2 advanced into LA
14. 6fr. PA loaded with Runthrough inserted into Agilis
15. 6fr JR4 guide loaded with .035x150 inserted into 8fr LFA sheath
16. Wire removed and Gooseneck inserted into JR4
17. Runthrough snared in AO
18. Runthrough externalized
19. PA catheter removed
20. 6fr. JL3.5 advanced over Runthrough
21. Second 6fr JR4 with J-wire advanced through second Agilis
22. Wire removed and Lampoon system advanced
23. Gooseneck snare inserted into JL3.5
24. IF ballooning leaflet for “Keyhole” technique make sure to keep wire straight until after ballooning
25. Leaflet traversed
    • Bovie settings: 30 cut to test and 70 cut for traversal and laceration
26. Snare Astato wire
27. Runthrough and Arterial guide removed
28. Pacer inserted
29. Balloon pump inserted
30. Leaflet lacerated
31. Guides and Lampoon System removed
    • Have one Agilis, SL1 and .032 wire ready to re-cross septum
32. Safari loaded in Pigtail and advanged to LV
33. Pigtail removed
34. Septostomy
35. Valve inserted and deployed
36. Pigtail used to remove Safari
37. 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.