Watchman
From Bay Area Structural Heart Wiki
Watchman - Left Atrial appendage closure | |||
---|---|---|---|
Anesthesia | Imaging | Access | ACIST/manifold |
General | Fluoro and TEE |
|
One manifold with contrast |
Pre-Procedure Watchouts | |||
PRE PROCEDURE: Type and Screen |
Type and Screen
Open
- Micropuncture
- 8fr sheath (dilator used pre-Perclose)
- Probe cover
- 1 Perclose
- 0-Prolene or 0-PDS (Spies will add a suture after perclose if site is oozing. If no ooze Exofin.)
- Cordis 150J
- 5fr Straight Pigtail
- 5fr MPA2 (Spies)
- 3-port manifold
- Baylis cable
- Grounding pad
Standby
- 4 or 5fr Pinnacle for Arterial line
- 190 Supracore
- Wholey / Versacore
Watchman supplies:
- 14fr Watchman access sheath (Open as requested after TEE)
- Watchman device (Size as requested after TEE)
PROCEDURE
- Basic table set up ONLY until it is determined by TEE that case will proceed.
- TEE performed. Procedure aborted if clot
- Prep bilateral groins and drape once probe has been inserted.
- Micropuncture ultrasound-guided RFV access
- 5 Fr Micropuncture sheath
- Baby J wire from sheath
- 8 Fr dilator
- 6 Fr Perclose pre-close RFV. .032 wire inserted after preclosure deployment.
- TEE & fluoro guided transeptal access & images of Left Atrial Appendage
- Anesthesia gives Heparin IV. ACT GOAL >250-300
- Transeptal puncture
- Measure LA pressure
- 14 Fr WATCHMAN delivery sheath either SINGLE, DOUBLE or ANTERIOR Curve
- 5 Fr Str Pigtail advanced to the LAA
- Hook pigtail up to manifold for angiogram of LAA
- Measure and select size of Watchman device
- Open and prep Watchman Device -
- Open touhy
- Exercise delivery
- Advance feet of device to just inside of marker
- Leave touhy open and attach to manifold with pressurized hep saline open, close touhy and flush to device. Tap through delivery system while flushing. (Size: 21, 24, 27, 30, 33mm)
- Pigtail removed just prior to delivery system insertion.
- Insert delivery with a wet-to-wet connection (leaving pressurized saline on)
- Once inserted, begin filling delivery system with contrast. Delivery system takes 20ml to fill.
- Deploy Device. Confirm placement to meet PASS criteria: Position Anchor, Size, Seal. Can be recaptured/reposition. Fully unscrew to deploy device.
- Placement confirmed by LA angiogram
- Delivery system removed as MD tamps perclose knot.
- If access is clean, Dermabond. If bleeding, woggle.
APPROVED: MD initials MM/YY