TMVI

Protip: Need Alcohol in lab for this procedure!

TransCatheter Mitral Valve Insertion

Per Rosalie:

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 charged 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.

TMVR
Anesthesia	Imaging	Access	Pre-Procedure
General Anesthesia A-Line Always!	Single Plane Fluoro TEE No Acist Unipolar pacing	RVF pre-closed x 1	Type and Cross Aspirin Given

Open:

Sheaths:

• Micropuncture
• 8fr Pinnacle for Perclose
• Perclose (If Spies is primary, NO perclose if Daniels is primary.)
• 8.5F Agilis
• 16F E sheath, always, regardless of valve size.

Wires:

• 150 J wire
• Safari 2

Baylis:

• VersaCross system
• Grounding pad

Misc:

• Naked 3 Port Manifold
• Alligator pacing cable

Catheters:

• 6fr. Straight Pig

Septal dilation:

• 12X4X75 Mustang for 23mm and 26mm Sapien or 14mm Armada for 29mm Sapien
• Presto indeflator

Edwards valve:

• Indeflator (Second Indeflator on standby)
• Crimper
• E-sheath (Second E-Sheath on standby)
• Delivery system (Second delivery on standby)
• Valve

Standby

Septal procedure:

• 9X4X75 Mustang
• 14, 16 XXL Balloons
• Torqueview 45DEGREE delivery system (9fr. or 10fr.)
• 10mm, 14mm, 18mm septal occluder

Baylis Standby

• SL1 sheath
• Large curve Baylis needle
• Baylis cable
• 0.32 x 260 J-wire

Bipolar pacing standby:

• 8x35 Brite tip
• 5F Josephson Pacing Cable
• EP Quad Cable
• Remington Pacing Cable
• (2) Pacer Boxes

Medications for table

• Bupivacaine/Lidocaine
• Epinephrine 10mcg/ml in red syringe on back table secured with steri-strip
• Rotaglide 10 ml (Edwards valve only!)

Procedure:

• Patient prepped from navel to knees in sterile fashion.  
• Access obtained with u/s
• Dilate with 8F dilator
• Pre-close, Versacross pigtail wire advanced through Perclose
• Versacross sheath inserted
• Transeptal puncture, then pigtail wire advanced
• Versacross sheath removed
• Agilis advanced and directed to mitral valve.
• Pigtail and Safari2 inserted through Agilis for valve crossing.
• Safari2 wire inserted to ventricle. Simultaneous LA/LV pressure recorded.
• Pigtail and Agilis removed.
• 12mm/14mm balloon advanced for septostomy and possible BAV
• Balloon removed, valve delivery system advanced.
• When valve is in place, black alligator cable attached and pacing tested.
• Valve deployed. Septum evaluated with echo for shunting.
• Delivery removed and SL1 re-advanced.
• Pigtail advanced to LV, wire removed and simultaneous LA/LV pressures recorded (maybe).
• Pigtail and SL1 removed.
• Pacer removed.
• Perclose completed and stitch to RFV
• Dermabond access site, no dressings needed.

ECMO Standby:

• 16fr. vented arterial cannula
• 21fr. venous cannula
• Perclose x 2
• ECMO instrument tray
• 180 Amplatz Super Stiff wire

Pericardiocentesis standby

• Eye drape
• 18g. x 10 cm. Chiba needle
• Skater introducer set
• Bard locking pigtail 6fr. or 8fr.
• 60ml syringe x 3
• Stopcock
• 180 Amplatz Super Stiff wire

---

APPROVED: MD initials MM/YY