Micra post TAVI

In the course of a TAVI, it is sometimes necessary to implant a leadless pacemaker. This facility uses the Micra device. This page will guide you on this procedure in the post-TAVI setting.

Already on the table:

• Micropuncture set
• 150 J-wire
• 2x 20cc syringes
• 1-2x 60cc syringes

Open:

• 14 and 22 coons dilators
• 0 PDS
• 180 Amplatz Super Stiff, 7cm tip
• Micra sheath from behind EP

If pt. is dependent on TPM and it is in the RFV, assume you will be switching the TPM to the LFV and open:

• New ultrasound probe cover
• 8.5 x 35 Brite-tip sheath
• 5fr. Ballon tip TPM catheter

Prep:

• Set ACIST at 5ml/sec, 20ml total (to fill syringes).
• 20 and 60cc syringes filled with Hep Saline
• Flush and assemble Micra Sheath
• RN preps hep saline on IV pump @ 125ml/hr

Procedure:

If on TPM

1. Access LFV and insert 8.5 Brite Tip
2. Insert balloon-tip TPM and establish capture
3. Wire RFV with Amplatz SS
4. Dilate and place Micra sheath
5. Attach Hep Saline drip
6. Micra delivery system is flushed gently with 60cc syringe and inserted
7. Fill delivery system with contrast
8. Before deployment, do LAO with contrast
9. Do RAO with saline flush (clears delivery system)
10. Deploy Micra
11. Tug test under 30 fps. cine
12. Flush delivery system with full 60 cc syringe
13. Pull suture
14. Remove delivery system
15. Place purse-string and woggle
16. Remove sheath