LAAO with Amulet

Pre-Procedure Watchouts: Type and Screen

Anesthesia	Imaging	Access	Acist/Manifold
Gernerl	Fluoro and TEE (ICE?)	12 Fr or 14Fr RFV	Manifold with contrast
Rep: Monica Tseng 415-816-2877

Open

• Micropuncture
• 8fr sheath (dilator used pre-Perclose)
• Probe cover
• 1 Perclose
  • 0-Prolene or 0-PDS (Spies will add a suture after perclose if site is oozing. If no ooze Exofin.)

• Cordis 150J

• 5fr Straight Pigtail
• 3-port manifold
• Baylis VersaCross Access System (purple box in structural cart)
• Grounding pad
• (Spies - Lido with EPI)

Standby

• 4 or 5fr Pinnacle for Arterial line

• 190 Supracore
• Wholey / Versacore

Amulet supplies:

• 12 Fr or 14 Fr Tourque View Delivery (Open as requested after TEE)
• Amulet device (Size as requested after TEE)

PROCEDURE

1. Basic table set up ONLY until it is determined by TEE that case will proceed.
2. TEE performed. Procedure aborted if clot
3. Prep bilateral groins and drape once probe has been inserted.
4. Micropuncture ultrasound-guided RFV access
5. 5 Fr Micropuncture sheath
6. Baby J wire from sheath
7. 8 Fr dilator
8. 6 Fr Perclose pre-close RFV. .032 wire inserted after preclosure deployment.
9. .035 J wire from versacross system advanced thru perclose for Baylis sheath advancement.
10. .035 J wire removed, VersaCross RF pigtail wire advanced for transeptal puncture.
11. TEE & fluoro guided transeptal access & images of Left Atrial Appendage
12. Anesthesia gives Heparin IV. ACT GOAL >250-300
13. Transeptal puncture, ACT drawn from LA.
14. Measure LA pressure
15. Tourque View Delivery advanced to the LA
16. Backloaded 5 Fr Str Pigtail advanced to the LAA
17. Hook pigtail up to manifold for angiogram of LAA
18. Measure and select size of device
19. Open and prep the device
20. Pigtail removed just prior to delivery system insertion.
21. Placement confirmed by LA angiogram
22. Delivery system removed as MD tamps perclose knot.
23. If access is clean, Dermabond. If bleeding, woggle