TMVI

TransCatheter Mitral Valve Repair/Replacement

Per Rosalie:

TAVR/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 charge 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.

GENERAL ANESTHESIA AND TEE IMAGING, RADIAL ART LINE BY ANESTHESIA

ACCESS 2 FEMORAL VEINS (TAVR AND PACER)

PRE PROCEDURE: TYPE AND CROSS, ASPIRIN GIVEN

SHEATHS:

• Micropuncture
• 8fr Pinnacle for Perclose
• 8x35 Brite tip
• 8.5 SL1
• 8.5 Small Curl Agilis

WIRES:

Open

• 150 J wire
• .032 x 260 J-wire
• Safari 2
• Amplatz Super Stiff 1cm tip

Standby

• .035 260CM J WIRE
• SUPRACORE 190CM

CATHETERS

Open

• 6fr. Straight Pig
• 5fr. MPB2

Standby

• 6F LANGSTON
• 5.2F ANGLED PIGTAIL
• 5F MPA
• 5F JL4 AND JR4 (FOR CORONARIES)

PACING

• 5F JOSEPHSON PACING CATHETER
• EP QUAD CABLE
• DUAL RED/BLACK REMINGTON PACING CABLE
• (2) PACER BOXES

VALVE TABLE

• (4) STERILE BOWLS (2- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX)
• (1) 90 INCH DRAPE (OR)
• 1L NORMAL SALINE IRRIGATION
• 500ML HEPARINIZED SALINE
• (1) 60ML SYRINGE
• (1) HIGH PRESSURE STOPCOCK
• (1) 20ML SYRINGE
• 30ML CONTRAST (MIX WITH 170ML HEP SALINE FOR 15% CONCENTRATION)

FOR EDWARDS VALVE

• INDEFLATOR
• CRIMPER
• E SHEATH
• DELIVERY SYSTEM
• VALVE

TRANS SEPTAL

• BAYLIS NEEDLE LARGE CURVE C1
• BAYLIS MACHINE
• BAYLIS CABLE
• GROUNDING PAD

SEPTAL DILATION

Open

• 12X4X75 MUSTANG OR 14X4 XXL (Ask before opening)
• PRESTO INDEFLATOR

Standby

• 9X4X75 MUSTANG
• 14, 16 XXL Balloons
• TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
• 10MM, 14MM, 18MM SEPTAL OCCLUDER

ADDITIONAL SUPPLIES

Open

• PERCLOSE
• 3 PORT MANIFOLD - No contrast
• PROBE COVER
• PROLENE 2-0
• FLUORO DRAPE
• CHLORAPREP AND PREP TRAY

Standby

• 150ML CONTRAST (FOR CORONARIES)
• BIOPATCH
• 8F ANGIOSEAL
• 0 SILK SUTURE
• EXTRA PERCLOSE

MEDICATIONS

• BUPIVACAINE
• EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE
• ROTAGLIDE 10ML (EDWARDS VALVE)

STANDBY EMERGENCY ECMO SUPPLIES

• 16F ARTERIAL CANNULA
• 21F VENOUS CANNULA
• (2) PERCLOSE
• ECMO INSTRUMENT TRAY
• AMPLATZ SUPER STIFF

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

PROCEDURE:

• Patient prepped from navel to knees in sterile fashion.  
• Access obtained with u/s

Typical sites:

• • • 14F OR 16F RFV E-sheath for valve delivery
      • Dilate with 8F
      • Preclose
• SL1 inserted over .032 260cm J
• Baylis needle inserted through SL1 and atrial septum puncture performed.
• Needle removed, .032 wire advanced to pulmonary vein
• Agilis advanced and directed to mitral valve
• Pigtail inserted through agilis for valve crossing.
• Safari2 wire inserted to ventricle.
• Pigtail and agilis removed.
• 12mm/14mm balloon advanced for septostomy and possible BAV
• Balloon removed, valve delivery system advanced.
• When valve is in place, temp pacer inserted and tested.
• Valve deployed. Septum evaluated with echo for shunting.
• Pacer removed. Delivery system removed.
• Preclosure closed and stitch to RFV
• 8F vein pulled and manual pressure applied
• Tegaderm both sides.

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APPROVED: MD initials MM/YY