Carotid TAVI

Procedure to be performed in Hybrid OR 14 in conjunction with the OR team.

Carotid TAVR
Anesthesia	Imaging	Access
General	Fluoro and TEE	Carotid cutdown Femoral Vein x1 Femoral Artery x1
Pre-Procedure Watchouts
colspan="3"	Transcutaneous O2 Sat MAP above 100

Equipment

In addition to standard TAVR equipment the OR team will need:

• Micropuncture
• 6F 10cm Pinnacle Sheath

We will need:

• Safari wire instead of Amplatz ES
• Can get away with 1 short J wire

Setup- Right Sided Carotid

• Anesthesia to get left sided A line
• Table at 30 degrees
• Bring C arm in perpendicular to table
• Echo at head of bed (TEE)
• OR will do prep. (Include groins and right wrist)
• First assist to stand at head of bed on the left
• CT surgeon on right side with scrub RN
• Cath Lab will have standard 2 tables plus high table for valve delivery.
  • mayo stand to bridge the gap between valve table and access site
• Cover Fluoro Pedal and Base of C-arm
• 2 venous extensions needed for Anesthesia
• Leave large boom to the side of the room. Use Monitors 3 &4 for pigtail and pacer.
  • 3 Live and 4 McKesson
• When DD moves to the head to assist with valve crossing bring in monitors 3 &4
  • 3- echo 4-Mckesson 1- Live 2- Anesthesia Vitals
  • Right wall monitor with quad view
  • boom with standard tavr display

Procedure- Right Sided

• Sheridan will start with cutdown.
• DD will obtain radial access for pigtail and femoral venous for Pacer
• AOgram per usual
• CTS inserts 6F sheath
• One CL tech stays at foot of bed for injections and pigtail pull
• Preloaded AL1 and Stiff glide inserted
• stiff glide exchanged for SAFARI
• E sheath inserted
• Valve delivered
• Venous sheath removed and figure 8 with prolene
• TR Band applied after OR finished closing.