TMVI - Encircle Sapien M3

Protip: Need Alcohol in lab for this procedure!

Warning:
THIS IS A RESEARCH PROCEDURE. ALL EDWARDS EQUIMENT WILL BE SUPPLIED BY THE RESEARCH TEAM.
DO NOT THROW AWAY ANY BOXES.

Warning: If broadcasting case:
DO NOT PUT PATIENT INFO INTO MCKESSON OR XRAY. PHI CANNOT BE STREAMED.
CASE INFO WILLL NEED TO BE MERGED AFTER THE PROCEDURE. PLEASE DO NOT SUBMIT CHARGES, ROSALIE WILL DO THEM.

Sapien M3
Anesthesia	Imaging	Access	Pre-Procedure
General Anesthesia A-line Possible Swan	Single plane fluoro 100% contrast in ACIST TEE	RFV pre-closed x 1 LFV for Pacer	Stabilizer placement prior to draping: 69cm from mid-sternum

Open:

Sheaths:

• Micropuncture set
• 8f Pinnacle
• 8fr x 35cm Brite-Tip
• 8.5fr SL1 transseptal sheath
• 22F coons dilator

Wires:

• (1) .035 150cm J wire
• (1) .035 260cm J wire
• (1) .032 260cm J wire
• (1) Safari Wire
• (1) Amplatz SS 260cm 1cm Tip

Catheters:

• (1) 6F Straight Pigtail
• 5F MPA1 125

Pacing:

• 5F Josephson Pacing Cable
• EP Quad Cable
• Remington Pacing Cable

Misc:

• Extra Sterile Bowl (3- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX)
• (3) 60ml Syringe
• (3) 20ml Syringe
• (3) High Pressure stopcock
• (1) Heparin tubing (updated with new device)
• (1) 72” pressure tubing (updated with new device)
• Extra manifold (For a gradient at the end)
• Perclose  
• 0-Prolene

Baylis:

• Baylis needle
• Baylis cable

Standby:

• Baylis ProTrack wire
• 6F ballon wedge
• 2530 Edwards indeflator
• 14X4 Armada Balloon
• PRESTO INDEFLATOR
• TORQUEVUE 45 DEGREE DELIVERY SYSTEM (9F OR 10F)
• 10MM, 14MM, 18MM SEPTAL OCCLUDER

Nurse Notes:

• ACIST- 100% CONTRAST
• 1L Hep Saline on Alaris IV pump set at: Pressure: 400 mmHg Rate: 400ml/hr - Click this link to see pressure adjustment process
• Grounding pad
• Baylis machine
• (2) Pacer Boxes
• Patient prepped from navel to knees in sterile fashion.  
• (1) Alaris pump (updated with new device)

MEDICATIONS

• Bupivicaine/Lidocaine Mixed 10mL each
• Epinephrine 10mcg/mL in red syringe on back table
• Rotaglide 10mL for sheath before valve is inserted

PROCEDURE

• Access obtained with u/s
• Need 20 and 60 cc flush on front table for the delivery system.
• 8F 35cm LFV for transcutaneous pacing
• RFV
• Dilate with 8F
• Preclose
• SL1 inserted over .032x260 wire
• Baylis needle inserted through SL1 and atrial septum puncture performed.
• Needle removed
• 5F MPA advanced over .032 wire
• 1cm Amplatz Super Stiff advanced and MPA and SL1 removed
• 23fr. Delivery sheath(GS) - Used for Doc and valve advanced
• Pigtail advanced across the mitral valve and LVgram @ 15/45 performed
• Mitral annulus denoted on live monitor screen in A plane
• DDS prepped
  • 1L Hep. Saline (2U/ml) bag with pressure bag spiked with heparin tubing, flushed, and attached to pump
  • Alaris settings 400ml/hr occlusion pressure limit 400mm Hg
  • Pressure tubing attached to stopcock and DDS
  • Swiftlink cover installed over pressure tubing and secured ~18” from off-table end
  • After hookup and flush, Swiftlink cover can be slid over heparin tubing for additional slack on the table.
• Dock Delivery System (DDS) advanced through GS
• Dock deployed in a timely fashion ;)
• Temp pacer inserted and tested.
• DDS removed and Pigtail inserted over exchange  J for valve crossing
• J wire exchanged for Safari 2
• Pigtail and GS removed
• Balloon removed
• Valve delivery system advanced
• Valve deployed. Septum evaluated with echo for shunting and PVL.
  • remind MD to lower FIO2*** Delivery system removed and MPA inserted for LA pressure measurement.
• (RHC performed with 6F swan to evaluate ASD)
• Safari retained across septum until shunt is evaluated
• All equipment removed
• Preclosure closed and stitch to RFV, manual pressure LFV
• Woggle vs Dermabond depending on Protamine

STANDBY EMERGENCY ECMO SUPPLIES

• 16F Arterial Cannula
• 21F Venous Cannula
• (2) Perclose
• ECMO Instrument Tray
• Amplatz SS 7cm tip

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

STANDBY PARAVALVULAR LEAK REPAIR SUPPLIES

SEE MITRAL PARAVALVULAR LEAK REPAIR

• AMPLATZER VASCULAR PLUG 2 SIZE 8-18 AVAILABLE

---

APPROVED: MD initials MM/YY