Valve in MAC with Antegrade Lampoon
GENERAL ANESTHESIA AND TEE IMAGING, RADIAL ART LINE BY ANESTHESIA
BIPLANE IMAGING
OVERLAY FOR SENTINEL
PRE PROCEDURE: TYPE AND CROSS, ASPIRIN GIVEN
MAC- Mitral Annular Calcification
https://www.jtcvs.org/article/S0022-5223(18)31545-9/pdf
Per Rosalie:
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).
MITRAL CLIP (Mitral/Tricuspid):
- 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
Access sites:
26F RFV
8F LFV
8F LFA
Open:
FROM STRUCTURAL HEART CART
.014 Astato xs 20 guidewire 180cm
Piggyback wire converter 4fr x 145
26F Dryseal
14mm Armada Balloon
SL1
Baylis Needle
Bovie pen
Grounding Pad
EXTRANEOUS SUPPLIES
(2) Watchdog devices
(2) Stopcocks
4 hemostats
(3) 60ml syringes
(2) 12 inch extension tubing
Bowl of D5
(2) Agilis SM Curl
Priority Pack
Balloon Pump
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
260cm Angled Glidewire
(2) .032 260cm J wire
(1) .035 260cm J wire
(1) .035 150cm J wire
300cm Grandslam
300 cm Runthrough wire
Safari
Amplatz SS 1cm
8F Sheath
6F JR4 Guide
6F JL3.5 Guide
7F JR4 Guide
5F MPA1
6F Straight Pigtail
5/6 Slender Sheath
18/30 Ensnare
25mm Gooseneck snare
Preclose x 3
0 Ethibond
0 Prolene x 2
Standby:
12F Flexcath
6F MP Guide
8F 90cm Shuttle sheath and 125cm Pigtail for measuring gradient post valve placement
Rough Procedural Plan:
Obtain access as listed above.
Preclose RFV x 2
Dryseal inserted
Preclose LFA
SL1- transeptal puncture
Amplatz SS through SL1
Exchange SL1 for 6F JR4
Double .032 in JR4
Agilis x 2 inserted
6F PA floated through one of the Agilis and glidewire inserted
PA catheter exchanged over glidewire for 6F JL3.5
Runthrough in 6F JR4 and snared through 7F in LV
7F JR4 with ensnare to LFA
6F JR4 through one of the agilis.
Runthrough in 6F JR4 and snared through 7F in LV
6F JR4 removed and reinserted over .032 wire---- or 6FMP??
Lampoon equipment advanced through 6F JR4/MP
6FJL3.5 advanced over Runthrough
25mm snare through JL3.5
Anterior leaflet traversed.-- Test bovie at 30 cut. Increase to 70 cut for traversal and laceration.
After leaflet traversal and system snared- 7F guide and Runthrough removed.
Balloon pump inserted.
Pacer inserted.
Leaflet lacerated.
Lampoon system deconstructed.
Pigtail advanced with Safari
Pigtail out.
Septostomy
Valve inserted and deployed.
Pigtail for wire removal
*ECMO??
*Possible ASD Closure
*Flow monitor on left leg?
