TMVI - Encircle Sapien M3
From Bay Area Structural Heart Wiki
Protip: Need Alcohol in lab for this procedure!
Warning:
THIS IS A RESEARCH PROCEDURE. ALL EDWARDS EQUIMENT WILL BE SUPPLIED BY THE RESEARCH TEAM.
DO NOT THROW AWAY ANY BOXES.
Warning: If broadcasting case:
DO NOT PUT PATIENT INFO INTO MCKESSON OR XRAY. PHI CANNOT BE STREAMED.
CASE INFO WILLL NEED TO BE MERGED AFTER THE PROCEDURE.
| Sapien M3 | |||||
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| Anesthesia | Imaging | Access | Pre-Procedure | ||
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Sheaths:
Open:
- Micropuncture set
- 8f Pinnacle
- 8fr x 35cm Brite-Tip
- 8.5fr SL1 transseptal sheath
- 22F coons dilator (or larger if we have it)
Wires:
Open:
- (1) .035 150cm J wire
- (1) .035 260cm J wire
- (1) .032 260cm J wire
- (1) Safari Wire
- (1) Amplatz SS 260cm 1cm Tip
Standby
- Baylis ProTrack wire
CATHETERS
Open
- (1) 6F Straight Pigtail
- 5F MPA1 125
Standby
- 6F ballon wedge
PACING
- 5F Josephson Pacing Cable
- EP Quad Cable
- Remington Pacing Cable
- (2) Pacer Boxes
VALVE TABLE
- (5) Sterile Bowls (3- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX)
- (1) 90 inch drape
- 1.5L Normal Saline
- 500ml Heparanized Saline
- (3) 60ml Syringe
- (3) 20ml Syringe
- (2) High Pressure stopcock
- 30mL Contrast (mixed with 170ml Hep Saline for 15% concentration)
TRANS SEPTAL
- BAYLIS NEEDLE LARGE CURVE C1
- BAYLIS MACHINE
- BAYLIS CABLE
- GROUNDING PAD
Standby
- 2530 Edwards indeflator
- 14X4 Armada Balloon
- PRESTO INDEFLATOR
- TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
- 10MM, 14MM, 18MM SEPTAL OCCLUDER
ADDITIONAL SUPPLIES
Open
- Extra manifold (For a gradient at the end)
- Perclose
- (3-4) 20ml syringes for flush (For DDS and sheath)
- ACIST- 100% CONTRAST
- 0-Prolene
- 1L Hep Saline on Alaris IV pump set at: Pressure: 400 mmHg Rate: 400ml/hr - Click this link to see pressure adjustment process
- (1) Alaris pump (updated with new device)
- (1) Heparin tubing (updated with new device)
- (1) 72” pressure tubing (updated with new device)
MEDICATIONS
- Bupivicaine/Lidocaine Mixed 10mL each
- Epinephrine 10mcg/mL in red syringe on back table
- Rotaglide 10mL for sheath before valve is inserted
STANDBY EMERGENCY ECMO SUPPLIES
- 16F Arterial Cannula
- 21F Venous Cannula
- (2) Perclose
- ECMO Instrument Tray
- Amplatz SS 7cm tip
STANDBY PERICARDIOCENTESIS SUPPLIES
- EYE DRAPE
- CHIBA NEEDLE 10CM 18G
- SKATER INTRODUCER SET
- BARD LOCKING PIGTAIL 6F OR 8F
- (3) 60ML SYRINGES
- STOPCOCK
- AMPLATZ SUPER STIFF 180CM
STANDBY PARAVALVULAR LEAK REPAIR SUPPLIES
SEE MITRAL PARAVALVULAR LEAK REPAIR
- AMPLATZER VASCULAR PLUG 2 SIZE 8-18 AVAILABLE
PROCEDURE
- Patient prepped from navel to knees in sterile fashion.
- Access obtained with u/s
- Need 20 and 60 cc flush on front table for the delivery system.
Typical sites:
- 8F 35cm LFV for transcutaneous pacing
- RFV
- Dilate with 8F
- Preclose
- SL1 inserted over .032x260 wire
- Baylis needle inserted through SL1 and atrial septum puncture performed.
- Needle removed
- 5F MPA advanced over .032 wire
- 1cm Amplatz Super Stiff advanced and MPA and SL1 removed
- 23fr. Delivery sheath(GS) - Used for Doc and valve advanced
- Pigtail advanced across the mitral valve and LVgram @ 15/45 performed
- Mitral annulus denoted on live monitor screen in A plane
- DDS prepped
- 1L Hep. Saline (2U/ml) bag with pressure bag spiked with heparin tubing, flushed, and attached to pump
- Alaris settings 400ml/hr occlusion pressure limit 400mm Hg
- Pressure tubing attached to stopcock and DDS
- Swiftlink cover installed over pressure tubing and secured ~18” from off-table end
- After hookup and flush, Swiftlink cover can be slid over heparin tubing for additional slack on the table.
- Dock Delivery System (DDS) advanced through GS
- Dock deployed in a timely fashion ;)
- Temp pacer inserted and tested.
- DDS removed and Pigtail inserted over exchange J for valve crossing
- J wire exchanged for Safari 2
- Pigtail and GS removed
- Balloon removed
- Valve delivery system advanced
- Valve deployed. Septum evaluated with echo for shunting and PVL.
- remind MD to lower FIO2*** Delivery system removed and MPA inserted for LA pressure measurement.
- (RHC performed with 6F swan to evaluate ASD)
- Safari retained across septum until shunt is evaluated
- All equipment removed
- Preclosure closed and stitch to RFV, manual pressure LFV
- Woggle vs Dermabond depending on Protamine
APPROVED: MD initials MM/YY
