BASILICA
From Bay Area Structural Heart Wiki
(Bioprosthetic Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction)
Open
- Dryseal sheath- size depending on valve, verify with MD before opening.
- 6fr MP1 guide catheter
- 7F sheath
- .018 Platinum Plus guidewire 260 cm
- Gooseneck Snare 20mm- VERIFY SIZE BEFORE OPENING
- 7 Fr AL2 (for LCA BASILICA) -OR- 7F MP1 Guide (For RCA BASILICA)
- .014 Astato xs 20 guidewire 180cm
- Piggyback wire converter 4fr x 145
- Bovie pen
- Grounding Pad
- Bovie machine
- (2) Watchdog devices
- (2) Stopcocks
- 4 hemostats
- (3) 60ml syringes
- (2) 12 inch extension tubing
- Bowl of D5
- Grandslam 300
- 5/6 Slender
- Sentinal (don't open until we pass the Grandslam)
Standby
- Tip deflecting wire
- Gooseneck snares 25, 30mm
- .035 QuickCross
- AL2, AL3, AL4, EBU4, EBU 3.75 (Left leaflet)
- MPA1, JR4, IM, AR1 (Right leaflet)
Procedure
- Setup and access is the same as TAVR except a 14F Dryseal sheath is inserted initially instead of the ESheath.
- Bovie set at 30 CUT ONLY.
- AL1 advanced over J wire through 7F sheath. Wire exchanged for straight stiff glidewire for valve crossing.
- AL1 exchanged over the wire for MP1 Guide with watchdog and stopcock attached.
- Platinum Plus wire is preshaped by MD and inserted through MP to retain LV access.
- Snare advanced through MP alongside Platinum Plus.
- BASILICA catheter advanced through Dryseal sheath with watchdog and stopcock attached.
- Kinked Astato wire advanced through BASILICA catheter.
- Hand injection performed to verify position of BASILICA catheter.
- Astato wire connected to bovie with 2 hemostats.
- RF applied as Astato wire advanced.
- Once wire penetrates leaflet it is snared and pulled into MP1.
- Platinum Plus wire removed
- Pacing wire advanced and tested
- AL1 advanced next to BASILICA catheter and valve recrossed in standard fashion.
- 60ml D5 filled syringes and extension tubing attached to sideports of guides and injected simultaneously during leaflet laceration.
- MP removed. BASILICA catheter removed.
- Amplatz ES advanced through AL1 and AL1 removed.
- Pigtail advanced to coronary cusp
- Dryseal exchanged for ESheath
- Do a TAVR.
Approved: MM/YY
