BATMAN

---BATMAN--- AND ---UNICORN--

• 18Fr Dryseal for non-inline Evolute (Confirm before opening)
• Amplatz Extra Stiff for Sheath advancement
• Suture for dryseal securement
• Micropuncture
• 8F sheath
• (2) .035 x 150 J wires
• .035 x 260 J wire
• Terumo Stiff Straight Glidewire 0.035 x 150 cm
• (2) Safari Wire
• (3) Perclose
• 7Fr MP1 Guide
• 5Fr AL1 diagnostic
• (2) 5Fr Ang Pigtail
• .014 Astato xs 20 guidewire 300cm
• FineCross 135cm
• Bovie pen
  • Grounding Pad
  • Bovie machine
• (2) Watchdog devices
• (2) Stopcocks
• (2) Needle drivers
• Alligator pacing wire
• Navicross

Standby - PULLED and HANGING on WALL

• Tip deflecting wire
• Sentinel

Additional Standby Items - don't need to have pulled

• MPA1, JR4, IM, AR1 (Right leaflet)

Procedure

• Setup and access is the same as TAVR except a 18F Dryseal sheath is inserted initially.
  • 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
• 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.