Mitral Clip

DRAFT

Mitral Clip
Anesthesia	Imaging	Access	Pre-Procedure
General	Fluoro, TEE, and ICE	Femoral Vein

Procedural Gems:

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

Big Equipment:

Open

• Cath pack
• Lift / Footstool / Support base
• Clear Plexiglass base support
• Sterile System Stabilizer
• Baylis generator (Mitral only)
• ICE 8fr. and SwiftLink cover (Tricuspid only)
  • 9fr x 23cm Pinnacle for ICE

Baylis/transseptal:

Not used for Tricuspid clipping

Open

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

Standby

• BRK1 transseptal needle (Rarely used)

Wires:

Open

• Cordis 150J
• Amplatz SuperStiff 1cm Tip

Standby

• .032 X 260 “J” wire
• .014 X 190 BMW wire

Catheters:

Open

• 5F MPA2
  

Misc supplies:

Open

• (2) 108cm High pressure IV Lines
• (5) High Pressure Stopcock
• 8F Sheath for dilator - (also used as a backup sheath)
• Perclose (x2 for Spies)
• 0 Prolene suture on a CT-1 needle (Spies)
• 4-0 Vicryl
• Pickups (Either from a suture removal kit or individual from SPD)
• (2) 60cc syringe
• 12” extension (Keep stickers to label flush tubing)
• (2) Sterile towel packs for back table
• 3 port manifold to measure LA pressure only (not needed for Tricuspid)
• 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 80cm from mid-sternum 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. Hand MD .032wire loaded into micropuncture sheath after Perclose deployment.
• SL1 introduced over .032 wire.
• Baylis needle inserted and echo imaging performed. Transseptal puncture performed.
• Baylis needle removed. .032wire inserted. Wire and dilator removed.
• MPA and Jwire inserted to pulmonary vein. LA pressure measured. Give MD Amplatz SuperStiff to shape.
• Jwire removed and 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 4 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 and Prolene used for groin closure.

Tricuspid Procedure

• MicroPuncture/US access
• Obtain RFV access, dilate with 8F, preclose.
• MPA2 loaded with J wire inserted. J wire removed for Amplatz Super Stiff.
• MPA2 removed.
• 20F dilator inserted and removed
• MitraClip Guide inserted.
• Proceed with normal case

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