TMVI

Daniels

Transcather Mitral Valve Replacement

GENERAL ANESTHESIA AND TEE IMAGING

ACCESS 2 FEMORAL VEINS (TAVR AND PACER), 1 FEMORAL ARTERY (ANESTESIA)

PRE PROCEDURE: TYPE AND CROSS, ASPIRIN GIVEN

SHEATHS:

• (1) 5F MICROPUNCTURE KIT
• (1) 5F 10CM SHEATH
  • • OR 6F IF CORONARY IMAGING NECESSARY
• (1) 8F 10CM SHEATH
• (1) 8F 35CM BRITE TIP SHEATH
• (1) 9F 10CM SHEATH
• (1) 8.5F 63CM SL1 TRANSSEPTAL SHEATH
• (1) 8.5F AGILIS SMALL CURL

WIRES:

Open

• (2) .035 150CM J WIRE
• (1) SAFARI 2 WIRE

Standby

• .035 260CM J WIRE
• AMPLATZ SUPER STIFF 1CM TIP
• SUPRACORE 190CM

CATHETERS

Open

• 6F STRAIGHT PIGTAIL 110CM

Standby

• 6F LANGSTON
• 5.2F ANGLED PIGTAIL
• 5F MPA
• 5F JL4 AND JR4 (FOR CORONARIES)

PACING

• 5F JOSEPHSON PACING CATHETER
• EP QUAD CABLE
• DUAL RED/BLACK REMINGTON PACING CABLE
• (2) PACER BOXES

VALVE TABLE

• (4) STERILE BOWLS (2- 0.9% SALINE, 1-HEP SALINE, 1-15% CONTRAST MIX)
• (1) 90 INCH DRAPE (OR)
• 1L NORMAL SALINE IRRIGATION
• 500ML HEPARINIZED SALINE
• (1) 60ML SYRINGE
• (1) HIGH PRESSURE STOPCOCK
• (1) 20ML SYRINGE
• 30ML CONTRAST (MIX WITH 170ML HEP SALINE FOR 15% CONCENTRATION)

FOR EDWARDS VALVE

• INDEFLATOR
• CRIMPER
• E SHEATH
• DELIVERY SYSTEM
• VALVE

TRANS SEPTAL

• BAYLIS NEEDLE LARGE CURVE C1
• BAYLIS MACHINE
• BAYLIS CABLE
• GROUNDING PAD

SEPTAL DILATION

Open

• 12X4X75 MUSTANG OR 14X4 XXL BALLOON (FROM IR)

SIZE DEPENDENT ON VALVE- CHECK WITH DANIELS BEFORE OPENING

• PRESTO INDEFLATOR

Standby

• 9X4X135 MUSTANG
• TORQUEVUE 45DEGREE DELIVERY SYSTEM (9F OR 10F)
• 10MM, 14MM, 18MM SEPTAL OCCLUDER

ADDITIONAL SUPPLIES

Open

• (2) PERCLOSE
• 3 PORT MANIFOLD  
• ACIST- FULL STRENGTH CONTRAST OK
• PROBE COVER
• DUMP BAG
• 25g 1½ INCH NEEDLE
• STAT LOCK WITH STRING SECUREMENT
• PROLENE 2-0
• TAVR INSTRUMENT TRAY
• CHLORAPREP AND PREP TRAY
• A LINE TUBING AND VENOUS EXTENSION FOR ANESTHESIA
• DERMABOND

Standby

• 150ML CONTRAST (FOR CORONARIES)
• BIOPATCH
• FLUORO DRAPE
• 8F ANGIOSEAL
• 0 SILK SUTURE
• EXTRA PERCLOSE

MEDICATIONS

• BUPIVACAINE
• EPINEPHRINE 10MCG/ML IN RED SYRINGE ON BACK TABLE
• ROTAGLIDE 10ML (EDWARDS VALVE)

STANDBY EMERGENCY ECMO SUPPLIES

• 16F ARTERIAL CANNULA
• 21F VENOUS CANNULA
• (2) PERCLOSE
• ECMO INSTRUMENT TRAY
• AMPLATZ SUPER STIFF

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

PROCEDURE:

• Patient prepped from navel to knees in sterile fashion.  
• Access obtained with u/s

Typical sites:

• • • 5F LFA for anesthesia monitoring
    • 8F 35cm LFV for transcutaneous pacing
    • 14F OR 16F RFV E-sheath for valve delivery
      • Dilate with 8F
      • Preclose
• SL1 inserted over .032 kit wire
• Baylis needle inserted through SL1 and atrial septum puncture performed.
• Needle removed, .032 wire advanced to pulmonary vein
• Agilis advanced and directed to mitral valve
• Pigtail inserted through agilis for valve crossing.
• Safari2 wire inserted to ventricle.
• Pigtail and agilis removed.
• 12mm/14mm balloon advanced for septostomy and possible BAV
• Balloon removed, valve delivery system advanced.
• When valve is in place, temp pacer inserted and tested.
• Valve deployed. Septum evaluated with echo for shunting.
• Pacer removed. Delivery system removed.
• Preclosure closed and stitch to RFV
• Perclose LFA
• 8F vein exchanged for 9F 10cm sheath
• Secure sheath with Statlock. Tegaderm both sides.