Open MVI
From Bay Area Structural Heart Wiki
Hybrid OR Procedure
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588478/
Supplies
Open
- TAVR pack
- Certitude system
- Crimper
- 29 valve
- 38 indeflator
- Safari wire
- 2x Perclose
- 8fr Pinnacle sheath
- Micropuncture
OR supplies cannula and Amplatz SS wires. Dave doesn’t like their micropuncture
Standby
- Sentinel
Bring
- TAVI cart
- CL to-go cart
- Small cath table
- Very small utility table
- 2 CL staff needed- 1 scrub 1 circulator/monitor
- Leave carts in the hall
- small cath table and small utility table in room for valve prep
- IF Sentinel:
- Surgical incision made first so anticoagulation can be performed after
- Preprep device
- Keep ACIST on cart and have ready to hook up, 100% contrast ok if creatnine ok
- IF CP Bypass cannulas inserted by IC
- 8F sheath first used for pigtail- AOgram for sentinel
- Preclose A x 2
- Standard ECMO equipment
- Don't open valve equipment until cannulas and sentinel in place (if using)
- Remove C arm after sentinel/cannula placement.
- Remove Sentinel BEFORE PROTAMINE
Procedure
Setup
- Arrange valve prep equipment on cath table
- Fluids as per usual for TAVR
- 1L Hep saline in medium and wire bowls
- 1L NACL in 2 bowls
- 30cc Visi in bowl
- Remove all gauze and countables. Keep 18g access needle, scalpel, and instruments.
- Setup on small cath table for valve sewing and crimping, small utility table for extra stuff
- Pt. in room. A-line, swan etc.
- Surgeon starts sewing valve
- Prep and drape
- Cardiologist inserts femoral cannulae same as ECMO.
- Surgeon opens chest
- When old valve is exposed, pre-crimp valve and confirm
- Crimp when ready, insert Safari into Certitude, and cut wire short (~1 foot out the back of the Certitude)
- Remove surgical obstructions and position valve under fluoro.
- Deploy valve
- Remove Certitude
- Close