Tip to Base Lampoon
Tip to Base Lampoon, also referred to as "Reverse Lampoon". Performed when VIV Mitral will likely cause LVOT obstruction.
| VIV Mitral with Tip to Base Lampoon | |||
|---|---|---|---|
| Anesthesia | Imaging | Access | ACIST/manifold |
| General | Biplane Fluoro and TEE | Femoral Vein x2
Femoral Artery x2 R Radial Artery |
ACIST with 100% contrast ok if normal creat
One manifold with contrast One naked manifold |
| Pre-Procedure Watchouts | |||
| |||
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).
Access Sites:
- 7F RFA
- 26F RFV (primary access)
- 7.5F LFA (for balloon pump)
- 8FLFV (for pacer)
- ACIST setup (if normal creatnine 100% contrast ok. only used for arch injection)
Open:
Wires:
- .032 260cm J wire
- .035 260cm J wire
- (2) .035 150cm J wire
- 300cm Grandslam
- Safari
- Amplatz SS 1cm
- .014 Astato xs 20 guidewire 300cm
Sheaths:
- 8F Sheath
- 7F Sheath
- 5/6 Slender Sheath
- 26F Dryseal
Catheters:
- 6F JR4 Guide
- 6F MP1 Guide
- 5F MPA1
- 6F Straight Pigtail
Misc:
- Perclose x 4
- Piggyback (??? Maybe finecross, verify preference)
- have extra one on standby. May want to put one on either side of flying v.
- 0 Ethibond
- 0 Prolene x 2
- Naked Manifold (simultaneous pressure measurements post procedure)
- 6F PA Catheter
- (2) Watchdog devices
- (2) Stopcocks
- 4 hemostats
- (3) 60ml syringes
- (2) 12 inch extension tubing
- Bowl of D5
- Agilis SM Curl
- Priority Pack
- 14mm Armada Balloon
- 25mm Gooseneck snare
- Balloon Pump
Pacing:
- 8F 35cm Brite Tip Sheath
- Josephson Pacing Wire
- Remington Cable
- Blue Pacing Cable
Transseptal:
- SL1
- Baylis Needle
- Bovie pen
- Grounding Pad
Standby:
Sentinel- opened after grandslam wire across great vessels
Be Ready For:
ECMO
Alcohol Septal Ablation
ASD Closure
Rough Procedural Plan
Obtain access as listed above.
Preclose RFV x 2 and dryseal inserted, sutured with Ethibond
Balloon pump inserted
Pigtail to arch for injection prior to sentinel. 6fps DSA.
Sentinel inserted
SL1- transeptal puncture
5F MP used for exchanging wires in LUPV
Amplatz SS advanced (do not go straight to agilis. put SS wire in for dryseal first)
SL1 exchanged for Dryseal
Agilis inserted through Dryseal
6F PA floated through Agilis over guidewire into AO
Guidewire exchanged for Astato
6F JR4 with gooseneck snare inserted through LFA.
Astato wire snared and pulled into JR4 Guide
PA catheter removed and 6F MP1 advanced over snared Astato.
Flying V formed on arterial side of wire
Finecross/Piggyback advanced over arterial side of astato wire
Flying V positioned over A2
Pacer Inserted
Cut at 50
Leaflet lacerated and verified on TEE
LAMPOON equipment removed
Pigtail advanced through Agilis
Safari wire inserted into LV
14mm Armada used for atrial septostomy
Valve inserted and deployed
If a post deployment gradient is needed, balloon pump will be removed and short 8F sheath exchanged for 8F 90cm shuttle sheath. 125cm pigtail inserted to LV. 2nd manifold needed.
Balloon Pump removed
Perclose LFA and RFA
Glue vs woggle depending on heparin reversal
