TAVI - Sapien 3 (Edwards)

Transcatheter Aortic Valve Repair (Wikipedia) procedures utilize a femoral approach to deliver a stent-based aortic valve to the patients heart. There are two valve types available:

• CoreValve by Medtronic - CoreValve Procedure Page
• Sapien 3 Ultra by Edwards - This page

This procedure is usually done in Room 1, and requires a 5 person team: Front table scrub, Back table scrub (device prep), Circulator, Pacer/Circulator, and Recorder. The rep for the respective company will be present to assist with device prep except in the case of an emergency valve placement.

In rare cases, the BASILICA procedure will be necessary to split the existing valve leaflets to prevent blockage of the coronary arteries. In that situation, the equipment on the BASILICA page will be needed in addition to the equipment listed below.

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.

Daniels/Spies - Draft

ACIST A1000V SYRINGE USED WITH 50/50 CONTRAST MIX

Sheaths:

• 5Fr Micropunture  Kit  
• 6Fr x 10cm sheath
• 8Fr x 10 cm sheath (Dilator used only)
• 8Fr x 35 cm Brite Tip Sheath
• 9Fr x 10cm sheath

Wires

• (2) Cordis 150J
• Cordis 260J
• Amplatz Extra Stiff 260cm
• Terumo Stiff Straight Glidewire 0.035 x 150 cm

Catheters:

• 5Fr AL1 diagnostic 
• 5Fr Ang Pigtail
• 5Fr JL4/JR4 (when doing coronary angiography)

Medications on table:

• Lido/Bupivicaine 50/50

• Epinephrine 10mcg/ml in red medallion syringe (From anesthesia)
• 10 ml Rotaglide

Miscellaneous Supplies

• 3-port manifold kit
• Acist hand control
• Suture Lock
• (4) Sterile Bowls
• Back table cover
• High Pressure stopcock
• 60ml syringe
• 20 ml syringe
• (3) Perclose
• Fluoro cover
• A & V extension line from anesthesia
• O- Ethibond
• 2-0 Prolene

Transvenous pacemaker supplies

• 5Fr Josephson Pacing catheter
• Dual Red/Black Pacing Remington cables
• EP Quad Cable

Procedure

Patient on defib pads. IF PATIENT HAS ICD: DEVICE DISABLED FOR PROCEDURE, COMPANY REP PRESENT IF POSSIBLE.

Leg strap secured above knees. Wrists restrained.

Patient prepped from naval to mid thigh using chlorahexidine soap followed by chloraprep with 3 minute dry time.

Towel off site. Extend Femoral drape all the way to chin.

Fluoro cover used to drape anesthesia's IV pole/x-ray shield.

Extension tubing for anesthesia flushed and secured on respecitve sides of the groin .

Dual pressure lines primed and zeroed prior to case start.

FRONT TABLE

50/50 Lido and Bupivicaine mix used for local anesthetic. Have extra available on front table.

100% contrast available on table. (May need for hand injection or for peripheral balloon prep)

10ml of Rotoglide on table (for E sheath just prior to valve insertion)

10ml syringe of 10mcg/ml taped on table.

U/S guidance for groin access

BACK TABLE- valve prep

4 Bowls: (2) Normal Saline (1) Hep Saline (1) 30ml contrast, 170ml Hep Saline mix (15%)

• Contrateral arterial access - 6fr. Sheath (normally LFA) using micropuncture. Verify wire position with fluoro and save an image.
• Primary access - with micropuncture. Verify wire position with fluoro and save an image
  • Leave micropuncture wire in while venous access is obtained
  • Once venous sheath is in place, dilate tract with 8F dilator
  • Double preclose.
  • After second perclose Amplatz ES is inserted using micropuncture sheath as a cheater

• Venous access- 8F 35cm brite tip over 150cm J wire. (Same side as TAVR sheath)

• Esheath sutured with 0-Ethibond
• Pigtail -> LFA -> AO root injection
  • Standard Injector settings:

• Insert and test pacemaker
• AL1 inserted into eSheath -> Str. Stiff glide
• Cross valve
• Measure gradient
• Amplatz ES -> LV
  • 8fr. Dilator on Amplatz ES as a cheater
• Insert valve delivery system
• Multiple AO grams for positioning
• Pace -> AO gram -> Pigtail pulled back -> Deploy valve
• TTE
• Pigtail advanced to AO for AO gram
• Amplatz ES exchanged for 260 J
• Delivery system removed
• Temp pacer removed
• Close primary access
• Iliac angio subtraction run for Primary access site
• Pigtail removed
• Secondary access Perclosed
• Venous sheath exchanged for 9fr. Sheath -> suture-locked

Not DD or CS

Call Echo

• Micropuncture
• 75 Amplatz SS
• Pericardiocentesis tray
• Accordion drain bag

Spies

Call Echo

Supplies:

• Micro puncture
• 150cm J wire
• 4/5fr slender sheath
• 5fr straight pigtail diagnostic
• gravity drainage bag
• brown reservoir lab canister
• Two 50 or 60ml syringes

Daniels

Call Echo

Supplies

Open

Emergency Kit located in each lab containing the following items:

• Eye drape
• Skater introducer set
• Bard locking pigtail (6f or 8f)
• (3) 60ml luer lock syringe
• Amplatz super stiff .035 180cm wire
• Probe cover
• Stopcock
• Accordion drainage bag

Standby

• Chiba biopsy needle 10cm 18g
• Standard .035 150cm j wire

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Approved: MM/YY