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: DO NOT PUT PATIENT INFO INTO MCKESSON OR XRAY. PHI CANNOT BE STREAMED. CASE INFO WILLL NEED TO BE MERGED AFTER THE PROCEDURE.
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| Anesthesia | Imaging | Access | Pre-Procedure | ||
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2/19 We used single plane with angles stored instead of biplane. Maybe new standard??ane
Sheaths:
Open:
- Micropuncture set
- 5/6 Slender Daniels sheath
- 8f Pinnacle
- 8fr x 35cm Brite-Tip
- 8.5fr SL1 transseptal sheath
Wires:
Open:
- (2) .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
- (2) 6F Straight Pigtail 110cm
- 5F MPA1
- 6F ballon wedge
Standby
- 6F MPA1 125cm
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
SEPTAL DILATION
Open
- 14X4 Armada Balloon- prepped
- PRESTO INDEFLATOR
Standby
- TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
- 10MM, 14MM, 18MM SEPTAL OCCLUDER
ADDITIONAL SUPPLIES
Open
- (2) Perclose
- ACIST- 100% CONTRAST
- (2)0-Prolene
- 2L Hep Saline on - Click this link to see pressure adjustment process
- That's right, I said IVY pole.
- (2) Alaris pump
- (2) Heparin tubing
- (2) 72” pressure tubing
- Swiftlink cover
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.
- ISOCENTER XRAY
- Access obtained with u/s
Typical sites
- 6F Right radial for Pigtail
- 8F 35cm LFV for transcutaneous pacing
- 20F RFV E-sheath for valve delivery
- Dilate with 8F
- Preclose
- SL1 inserted over .032 kit 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
- Edwards Guide Sheath (GS) advanced
- Pigtail advanced through 6F sheath and LVgram @ 15/45 performed
- Change ACIST to 5/5 after lvgram
- Mitral annulus denoted on live monitor screen in A plane
- DDS prepped
- 1L Hep. Saline (2U/ml) bags with pressure bags spiked with heparin tubing, flushed, and attached to pump
- Alaris settings 200ml/hr occlusion pressure limit 300mm 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
- Change fluoro to 4fps once DDS is in place and dock deployment begins.
- 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
- 14mm balloon advanced for septostomy
- 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
- All equipment removed
- Preclosure closed and stitch to RFV, manual pressure LFV
- Woggle vs Dermabond depending on Protamine
APPROVED: MD initials MM/YY
