Mitral Clip

DRAFT

Mitral Clip
Anesthesia	Imaging	Access
General	Fluoro, TEE	4F Femoral Vein for drawing ACT's ** If functional MR/low EF Anesthesia to obtain A line and femoral vein sheath not necessary.
Pre-Procedure Watchouts
* Tidal volume during time-out!

Procedural Gems:

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

Charges: MITRAL CLIP (Mitral/Tricuspid):

1. Use the device set "CL ITEMS NOT SCANNING"– Mitraclip G4 - consists of (1) Steerable Guide Catheter, (2) NTR Clip Delivery System & (1) XTR Clip Delivery System.

Big Equipment:

Open

• Cath pack
• Lift / Footstool / Support base
• Clear Plexiglass base support
• Sterile System Stabilizer
• Baylis generator

Baylis/transseptal:

Open

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

Wires:

Open

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

Catheters:

Open

• 5F MPA2

Misc supplies:

Open

• 4fr. Pinnacle sheath for ACT (not needed if anesthesia has an A line.)
• (2) 108cm High pressure IV Lines
• (5) Stopcocks
• 8F Sheath for dilator - (also used as a backup sheath)
• (2)Perclose
• (2) 60cc syringe
• (2) 12” extension (Keep stickers to label flush tubing)
• Sterile towel pack for back table
• Naked 3-port manifold to measure LA pressure only
• 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.

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