TMVI: Difference between revisions

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* General Anesthesia
* General Anesthesia


* A-Line
* A-Line Always!
|
|
* Single Plane Fluoro
* Single Plane Fluoro
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*Micropuncture
*Micropuncture
*8fr Pinnacle for Perclose
*8fr Pinnacle for Perclose
*Perclose
*Perclose (If Spies is primary, NO perclose if Daniles is primary.)
*8. 5F Agilis
*16F E sheath, '''always''', regardless of valve size.
*16F E sheath, '''always''', regardless of valve size.


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


=== TRANSEPTAL EQUIPMENT: ===
===* NEW - Baylis Transseptal===
*8.5F SL1
 
*Baylis Needle
* VersaCross system
* Grounding pad
 
===Bellow items on standby!===*SL1 sheath
* Large curve Baylis needle
*Baylis cable
*Baylis cable
*Grounding pad
*0.32 x 260 J-wire
*8.5F Agilis
 
=== MISC: ===
=== MISC: ===
*Naked 3 Port Manifold
*Naked 3 Port Manifold
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*6fr. Straight Pig
*6fr. Straight Pig
*5fr. MPA2


=== SEPTAL DILATION: ===
=== SEPTAL DILATION: ===
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*Access obtained with u/s
*Access obtained with u/s
*Dilate with 8F dilator
*Dilate with 8F dilator
*Preclose  
*Preclose, Versacross pigtail wire advanced through perclose
*SL1 inserted over .032 260cm J ( Don't use wire that comes with SL1 - toss off table)
*Versacross sheath inserted
*Baylis needle inserted through SL1 and atrial septum puncture performed.
*Transeptal puncture, then pigtail wire advanced
*Needle removed, LA pressure recorded. .032 wire advanced to pulmonary vein
*Versacross sheath removed
*MP advanced to LUPV, .032 wire removed and super stiff advanced
*MP and SL1 removed. E Sheath advanced.
*Agilis advanced and directed to mitral valve.
*Agilis advanced and directed to mitral valve.
*Pigtail and Safari2 inserted through Agilis for valve crossing.
*Pigtail and Safari2 inserted through Agilis for valve crossing.

Latest revision as of 22:13, 9 May 2024

Note Warning: This page needs revision!
Note Protip: Need Alcohol in lab for this procedure!

TransCatheter Mitral Valve Repair/Replacement

Per Rosalie:

TAVR/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 charge 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 Daniles is primary.)
  • 8. 5F Agilis
  • 16F E sheath, always, regardless of valve size.

WIRES:

  • 150 J wire
  • Safari 2

* NEW - Baylis Transseptal

  • VersaCross system
  • Grounding pad

===Bellow items on standby!===*SL1 sheath

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

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

BIPOLAR PACING ON STANDBY:

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

FOR EDWARDS VALVE:

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

Standby

  • 9X4X75 MUSTANG
  • 14, 16 XXL Balloons
  • TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
  • 10MM, 14MM, 18MM SEPTAL OCCLUDER

MEDICATIONS

  • BUPIVACAINE
  • EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE
  • ROTAGLIDE 10ML (EDWARDS VALVE)

PROCEDURE:

  • Patient prepped from navel to knees in sterile fashion.  
  • Access obtained with u/s
  • Dilate with 8F dilator
  • Preclose, 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.
  • Preclosure completed and stitch to RFV
  • Dermabond access site, no dressings needed.


STANDBY EMERGENCY ECMO SUPPLIES

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

STANDBY PERICARDIOCENTESIS SUPPLIES

  • EYE DRAPE
  • CHIBA NEEDLE 10CM 18G
  • SKATER INTRODUCER SET
  • BARD LOCKING PIGTAIL 6F OR 8F
  • (3) 60ML SYRINGES
  • STOPCOCK
  • AMPLATZ SUPER STIFF 180CM


APPROVED: MD initials MM/YY

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