BASILICA
From Bay Area Structural Heart Wiki
(Bioprosthetic Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction)
Open
- 14 F Dryseal sheath (Confirm before opening)
- Amplatz Extra Stiff for Sheath advancement
- Suture for dryseal securement
- 6fr MP1 guide catheter
- 7F sheath
- .018 Platinum Plus guidewire 260 cm
- Gooseneck Snare 20mm- VERIFY SIZE BEFORE OPENING
- 7 Fr AL2 (for LCA BASILICA) -OR- 7F MP1 Guide (For RCA BASILICA)
- .014 Astato xs 20 guidewire 180cm
- Piggyback wire converter 4fr x 145
- Bovie pen
- Grounding Pad
- Bovie machine
- (2) Watchdog devices
- (2) Stopcocks
- (4) Needle drivers
- (3) 60ml syringes
- (2) 12 inch extension tubing
- Bowl of D5
- Grandslam 300
- 5/6 Slender
- Sentinal (don't open until we pass the Grandslam)
Standby
- Tip deflecting wire
- Gooseneck snares 25, 30mm
- .035 QuickCross
- AL2, AL3, AL4, EBU4, EBU 3.75 (Left leaflet)
- MPA1, JR4, IM, AR1 (Right leaflet)
Procedure
- Setup and access is the same as TAVR except a 14F Dryseal sheath is inserted initially instead of the ESheath.
- 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
- Pacing wire advanced and tested
- 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.
Double BACILICA
- 18F Dryseal and 14F Dryseal (No 7F sheath)
- (2) 6F MP1
- (2) Goose Neck Snares (one platinum plus, once first leaflet is traversed the platinum plus is removed and can be used for other leaflet)
- (4) Watchdogs and stopcocks
- (6) Needle drivers
- (2) .014 Astato xs 20 guidewire 180cm
- (2) Piggyback wire converter 4fr x 145
18F Dryseal on primary side. Once both leaflets are traversed, do valve check and place pacemaker. Platinum Plus removed. AL1 advanced and valve recrossed. Pigtail left in LV for retention. Right leaflet is lacerated, equipment removed. Pigtail removed over delivery wire. Valve delivery advanced and left indwelling in aorta. Left leaflet lacerated and equipment removed. Valve deployed.
Approved: MM/YY
