LAAO with Amulet
From Bay Area Structural Heart Wiki
| Anesthesia | Imaging | Access | Acist/Manifold |
|---|---|---|---|
| Gernerl | Fluoro and TEE (ICE?) | 12 Fr or 14Fr RFV | Manifold with contrast, connect 1L hep saline bag not 500 |
Rep: Monica Tseng 415 8162877
| |||
Open
- Micropuncture
- 8fr sheath (dilator used pre-Perclose)
- Probe cover
- 1 Perclose
- 0-Prolene or 0-PDS (Spies will add a suture after perclose if site is oozing. If no ooze Exofin.)
- Cordis 0.35x150J-wire
- 6fr Straight Pigtail
- 3-port manifold (For Dr. Spies always attach dump bag to manifold)
- Baylis VersaCross Access System (purple box in structural cart)
- 1 watchdog or copilot
- 1 stopcock
- Grounding pad
- (Spies - Lido with EPI)
Standby
- 4 or 5fr Pinnacle for Arterial line
- 190 Supracore
- Wholey / Versacore
Amulet supplies: (supplies provided by Rep.)
- 12 Fr or 14 Fr Tourque View Delivery (Open as requested after TEE)
- Amulet device (Size as requested after TEE)
PROCEDURE
- Basic table set up ONLY until it is determined by TEE that case will proceed.
- TEE performed. Procedure aborted if clot
- Prep bilateral groins and drape once probe has been inserted.
- Micropuncture ultrasound-guided RFV access
- 5 Fr Micropuncture sheath
- Baby J wire from sheath
- 8 Fr dilator
- 6 Fr Perclose pre-close RFV.
- .035 J wire from versacross system advanced thru perclose for Baylis sheath advancement.
- .035 J wire removed, VersaCross RF pigtail wire advanced for transeptal puncture.
- TEE & fluoro guided transeptal access & images of Left Atrial Appendage
- Anesthesia gives Heparin IV. ACT GOAL >250-300
- Transeptal puncture, ACT drawn from LA.
- Measure LA pressure
- Tourque View Delivery advanced to the LA
- Backloaded 6 Fr Str Pigtail advanced to the LAA
- Hook pigtail up to manifold for angiogram of LAA
- Measure and select size of device
- Open and prep the device. Device hooks up to constant flush on manifold to be prepped.
- Pigtail and Watchdog/copilot removed just prior to delivery system insertion.
- Placement confirmed by LA angiogram
- Delivery system removed as MD tamps perclose knot.
- If access is clean, Dermabond. If bleeding, woggle
