Tip to Base Lampoon

Tip to Base Lampoon, also referred to as "Reverse Lampoon". Performed when VIV Mitral will likely cause LVOT obstruction.

VIV Mitral with Tip to Base Lampoon
Anesthesia	Imaging	Access	ACIST/manifold
General	Biplane Fluoro and TEE	Femoral Vein x2 Femoral Artery x2 R Radial Artery	ACIST with 100% contrast ok if normal creat One manifold with contrast One naked manifold
Pre-Procedure Watchouts
Request alcohol from pharmacy

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).

Access Sites:

7F RFA

26F RFV (primary access)

7.5F LFA (for balloon pump)

8FLFV (for pacer)

Open:

FROM STRUCTURAL HEART CART

.014 Astato xs 20 guidewire 300cm

Piggyback (??? Maybe finecross, verify preference)

- have extra one on standby. May want to put one on either side of flying v.

26F Dryseal

14mm Armada Balloon

25mm Gooseneck snare

SL1

Baylis Needle

Bovie pen

Grounding Pad

MISC SUPPLIES

(2) Watchdog devices

(2) Stopcocks

4 hemostats

(3) 60ml syringes

(2) 12 inch extension tubing

Bowl of D5

Agilis SM Curl

Priority Pack

Balloon Pump

ACIST setup (if normal creatnine 100% contrast ok. only used for arch injection)

Naked Manifold (simultaneous pressure measurements post procedure)

FROM STORE ROOM

8F 35cm Brite Tip Sheath

Josephson Pacing Wire

Remington Cable

Blue Pacing Cable

Sentinel- opened after grandslam wire across great vessels

FROM ROOM SUPPLIES

6F PA Catheter

.032 260cm J wire

.035 260cm J wire

(2) .035 150cm J wire

300cm Grandslam

Safari

Amplatz SS 1cm

8F Sheath

7F Sheath

6F JR4 Guide

6F MP1 Guide

5F MPA1

6F Straight Pigtail

5/6 Slender Sheath

Perclose x 4

0 Ethibond

0 Prolene x 2

Be Ready For:

ECMO

Alcohol Septal Ablation

ASD Closure

Rough Procedural Plan

Obtain access as listed above.

Preclose RFV x 2 and dryseal inserted, sutured with Ethibond

Balloon pump inserted

Pigtail to arch for injection prior to sentinel. 6fps DSA.

Sentinel inserted

SL1- transeptal puncture

5F MP used for exchanging wires in LUPV

Amplatz SS advanced (do not go straight to agilis. put SS wire in for dryseal first)

SL1 exchanged for Dryseal

Agilis inserted through Dryseal

6F PA floated through Agilis over guidewire into AO

Guidewire exchanged for Astato

6F JR4 with gooseneck snare inserted through LFA.

Astato wire snared and pulled into JR4 Guide

PA catheter removed and 6F MP1 advanced over snared Astato.

Flying V formed on arterial side of wire

Finecross/Piggyback advanced over arterial side of astato wire

Flying V positioned over A2

Pacer Inserted

Cut at 50

Leaflet lacerated and verified on TEE

LAMPOON equipment removed

Pigtail advanced through Agilis

Safari wire inserted into LV

14mm Armada used for atrial septostomy

Valve inserted and deployed

If a post deployment gradient is needed, balloon pump will be removed and short 8F sheath exchanged for 8F 90cm shuttle sheath. 125cm pigtail inserted to LV. 2nd manifold needed.

Balloon Pump removed

Perclose LFA and RFA

Glue vs woggle depending on heparin reversal