TMVI

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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.

GENERAL ANESTHESIA AND TEE IMAGING, RADIAL ART LINE BY ANESTHESIA

ACCESS 2 FEMORAL VEINS (TAVR AND PACER)

PRE PROCEDURE: TYPE AND CROSS, ASPIRIN GIVEN

SHEATHS:

• Micropuncture
• 8fr Pinnacle for Perclose
• 8x35 Brite tip
• 8.5F SL1
• 8.5F Tourguide
• 16F E sheath, always, regardless of valve size.

WIRES:

Open

• 150 J wire
• .032 x 260 J-wire
• Safari 2
• Amplatz Super Stiff 1cm tip

CATHETERS

Open

• 6fr. Straight Pig
• 5fr. MPA2
• Naked 3 Port Manifold

PACING

• 5F Josephson Pacing Cable
• EP Quad Cable
• Remington Pacing Cable
• (2) Pacer Boxes

FOR EDWARDS VALVE

• INDEFLATOR
• CRIMPER
• E SHEATH
• DELIVERY SYSTEM
• VALVE

TRANS SEPTAL

• BAYLIS NEEDLE LARGE CURVE C1
• BAYLIS MACHINE
• BAYLIS CABLE
• GROUNDING PAD

SEPTAL DILATION

Open

• 12X4X75 MUSTANG for 23mm and 26mm sapien 14mm Armada for 29mm sapien
• PRESTO INDEFLATOR

Standby

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

ADDITIONAL SUPPLIES

Open

• 2xPERCLOSE
• PROBE COVER
• CHLORAPREP AND PREP TRAY

MEDICATIONS

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

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

PROCEDURE:

• Patient prepped from navel to knees in sterile fashion.  
• Access obtained with u/s

Typical sites:

14F OR 16F RFV E-sheath for valve delivery

• Dilate with 8F dilator
• Preclose x 2.
• SL1 inserted over .032 260cm J ( Don't use wire that comes with SL1 - toss off table)
• Baylis needle inserted through SL1 and atrial septum puncture performed.
• Needle removed, LA pressure recorded. .032 wire advanced to pulmonary vein
• MP advanced to LUPV, .032 wire removed and super stiff advanced
• MP and SL1 removed. E Sheath advanced.
• Tourguide advanced and directed to mitral valve.
• Pigtail and Safari2 inserted through tourguide for valve crossing.
• Safari2 wire inserted to ventricle. Simultaneous LA/LV pressure recorded.
• Pigtail and tourguide removed.
• 12mm/14mm balloon advanced for septostomy and possible BAV
• Balloon removed, valve delivery system advanced.
• When valve is in place, temp pacer inserted and tested.
• Valve deployed. Septum evaluated with echo for shunting.
• Delivery removed and SL1 readvanced.
• Pigtail advanced to LV, wire removed and simultaneous LA/LV pressures recorded.
• Pigtail and SL1 removed.
• Pacer removed.
• Preclosure completed and stitch to RFV
• 8F vein pulled and manual pressure applied
• Dermabond access site, no dressings needed.

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APPROVED: MD initials MM/YY