Mitral Clip

DRAFT

Mitral Clip
Anesthesia	Imaging	Access	Pre-Procedure
General	Fluoro, TEE, and ICE	Femoral Vein

The Tricuspid clip now has its own page at Tricuspid Clip

Procedural Gems:

• When using the PDOII plug In MitraClip setting use TorqView 180 (smaller cable needed)

Big Equipment:

Open

• Cath pack
• Lift / Footstool / Support base
• Clear Plexiglass base support
• Sterile System Stabilizer
• Baylis generator (Mitral only)
• ICE 8fr. and SwiftLink cover (Tricuspid only)
  • 9fr x 23cm Pinnacle for ICE

Baylis/transseptal:

Not used for Tricuspid clipping

Open

• SL1 TransSeptal sheath
• Large curve Baylis needle
• Baylis cable
• Grounding pad

Wires:

Open

• .032 X 260 “J” wire
• Amplatz SuperStiff 1cm Tip
• 150J

Catheters:

Open

• 5F MPA2
  

Misc supplies:

Open

• (2) 108cm High pressure IV Lines
• (5) Stopcocks
• 8F Sheath for dilator - (also used as a backup sheath)
• (1)Perclose
• 4-0 Vicryl/monocryl
• Pickups (Either from a suture removal kit or individual from SPD)
• (2) 60cc syringe
• 12” extension (Keep stickers to label flush tubing)
• Sterile towel pack for back table
• 3 port manifold to measure LA pressure only (not needed for Tricuspid)
• Fluoro cover to anesthesia IV pole or moving xray shield
• 20F Dilator
• Micropuncture
• U/S probe cover

Standby

• 20fr. DrySeal for recovering wire to LUPV
• Additional Perclose
• Pericardiocentesis supplies

Non-Sterile Supplies

• (2) Liter bags of heparinized saline
• (2) Liter sized pressure bags

Procedure

• Anesthesia will obtain radial art line prior to draping.
• Pre procedure TEE imaging performed

• Prior to prepping patient, place MitraClip Plate (plexiglass board – hinge side up) under patient’s leg off center to the right. Place MitralClip Lift (step stool) over patients right leg, angled down towards the head. Measure 75cm from subxyphoid to leading edge of stool. Make sure there is direct contact between stool and plate.

• Prep patient and drape per usual. Drape anesthesia pole and/or xray shield.
• Obtain RFV access, dilate with 8F, preclose. .032 wire inserted into perclose.
• SL1 introduced over .032 wire.
• Baylis needle inserted and echo imaging performed. Transseptal puncture performed.
• Baylis needle removed. .032wire inserted. Dilator removed
• MPA advanced over the wire to pulmonary vein. LA pressure measured. Give MD Amplatz SuperStiff to shape.
• Amplatz SuperStiff advanced.
• MPA removed.
• SL1 removed
• 20F dilator inserted and removed
• MitraClip Guide inserted.
• Setup stabilizer and silicone sheet. Hand MD 60ml syringe with short extension tubing for aspiration.
• Amplatz wire and dilator removed. Clip inserted.
• Drips should be maintained at 1 drip every 3 seconds. If bubbles are seen on echo, turn drips down.
• When clip is being deployed turn room lights up and drips up. Place bowl below to catch drips while deploying.
• Hand MD 60ml syringe with extension tubing for aspiration while delivery system is removed.
• LA pressure measured. Set up for subsequent clips if needed.
• Vicryl used for groin closure.

Tricuspid Procedure

• MicroPuncture/US access
• Obtain RFV access, dilate with 8F, preclose.
• MPA2 loaded with J wire inserted. J wire removed for Amplatz Super Stiff.
• MPA2 removed.
• 20F dilator inserted and removed
• MitraClip Guide inserted.
• Proceed with normal case

BACK TABLE SETUP

• 108" Tubing spikes handed off to circulator, keep rollers on sterile field.

• Follow Rep instructions for device prep.

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APPROVED: MD initials MM/YY