Tip to Base Lampoon
Tip to Base Lampoon, also referred to as "Reverse Lampoon". Performed when VIV Mitral will likely cause LVOT obstruction.
| VIV Mitral with Tip to Base Lampoon | |||
|---|---|---|---|
| Anesthesia | Imaging | Access | ACIST/manifold |
| General | Biplane Fluoro and TEE | Femoral Vein x2
Femoral Artery x2 R Radial Artery |
ACIST with 100% contrast ok if normal creat
One manifold with contrast One naked manifold |
| Pre-Procedure Watchouts | |||
| |||
TAVR/TMVI
- 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).
- Medtronic Core Valve – all items are charge separately. Scan all barcodes (delivery system, loading system and valve).
Access Sites:
7F RFA
26F RFV (primary access)
7.5F LFA (for balloon pump)
8FLFV (for pacer)
Open:
FROM STRUCTURAL HEART CART
.014 Astato xs 20 guidewire 300cm
Piggyback (??? Maybe finecross, verify preference)
- have extra one on standby. May want to put one on either side of flying v.
26F Dryseal
14mm Armada Balloon
25mm Gooseneck snare
SL1
Baylis Needle
Bovie pen
Grounding Pad
MISC SUPPLIES
(2) Watchdog devices
(2) Stopcocks
4 hemostats
(3) 60ml syringes
(2) 12 inch extension tubing
Bowl of D5
Agilis SM Curl
Priority Pack
Balloon Pump
ACIST setup (if normal creatnine 100% contrast ok. only used for arch injection)
Naked Manifold (simultaneous pressure measurements post procedure)
FROM STORE ROOM
8F 35cm Brite Tip Sheath
Josephson Pacing Wire
Remington Cable
Blue Pacing Cable
Sentinel- opened after grandslam wire across great vessels
FROM ROOM SUPPLIES
6F PA Catheter
.032 260cm J wire
.035 260cm J wire
(2) .035 150cm J wire
300cm Grandslam
Safari
Amplatz SS 1cm
8F Sheath
7F Sheath
6F JR4 Guide
6F MP1 Guide
5F MPA1
6F Straight Pigtail
5/6 Slender Sheath
Perclose x 4
0 Ethibond
0 Prolene x 2
Be Ready For:
ECMO
Alcohol Septal Ablation
ASD Closure
Rough Procedural Plan
Obtain access as listed above.
Preclose RFV x 2 and dryseal inserted, sutured with Ethibond
Balloon pump inserted
Pigtail to arch for injection prior to sentinel. 6fps DSA.
Sentinel inserted
SL1- transeptal puncture
5F MP used for exchanging wires in LUPV
Amplatz SS advanced (do not go straight to agilis. put SS wire in for dryseal first)
SL1 exchanged for Dryseal
Agilis inserted through Dryseal
6F PA floated through Agilis over guidewire into AO
Guidewire exchanged for Astato
6F JR4 with gooseneck snare inserted through LFA.
Astato wire snared and pulled into JR4 Guide
PA catheter removed and 6F MP1 advanced over snared Astato.
Flying V formed on arterial side of wire
Finecross/Piggyback advanced over arterial side of astato wire
Flying V positioned over A2
Pacer Inserted
Cut at 50
Leaflet lacerated and verified on TEE
LAMPOON equipment removed
Pigtail advanced through Agilis
Safari wire inserted into LV
14mm Armada used for atrial septostomy
Valve inserted and deployed
If a post deployment gradient is needed, balloon pump will be removed and short 8F sheath exchanged for 8F 90cm shuttle sheath. 125cm pigtail inserted to LV. 2nd manifold needed.
Balloon Pump removed
Perclose LFA and RFA
Glue vs woggle depending on heparin reversal
