TMVI - Encircle Sapien M3
From Bay Area Structural Heart Wiki
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. DOCUMENTATION NOTES IN RESEARCH HELPER IN CUPID.
Warning: If broadcasting case:
DO NOT PUT PATIENT INFO INTO 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 | |||||
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| Anesthesia | Imaging | Access | Pre-Procedure | ||
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Open:
Sheaths:
- Micropuncture set (for woggle with Daniels, or Access and Woggle for Spies)
- 8f Pinnacle
Wires:
- (1) .035 150cm J wire
- (1) .035 260cm J wire
- (1) Safari Wire
Catheters:
- 6F Straight Pigtail
Pacing:
Unipolar pacing setup
- Alligator cables
Bipolar on standby
- Alligator Pacing Cable (open)
- 5F Josephson Pacing Cable (Standby)
- EP Quad Cable (Standby)
- Remington Pacing Cable (Standby)
- 8F 35cm BriteTip Sheath (Standby)
Misc:
- Back table needs 5 bowls total. Use TAVR pack, and drop 2 extra small bowls. (3 of 0.9% Saline, 1 large bowl hep-saline, 1 contrast mix 15%)
- (2) 60ml Syringe
- (4) High Pressure stopcock
- (1) 84" tubing to connect with pump off table (same as A-line anesthesia tubing)
- 3 port manifold (For a gradient at the end)
- (1) Perclose (If Spies is primary, NO perclose if Daniles is primary.)
- 0-Prolene for woggle
* NEW - Baylis Transseptal source
- VersaCross system
- Grounding pad
Bellow items on standby!
- SL1 sheath
- Large curve Baylis needle
- Baylis cable
- (1) 0.32 260 J-wire
- 5F MPA
- (1) Amplatz SS 260cm 1cm Tip
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 PLUM 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) Plum pump
MEDICATIONS
- Bupivicaine/Lidocaine Mixed 10mL each
- Epinephrine 10mcg/mL in red syringe on back table
Back Table Set Up
- (3) bowls with 500 ml of NS
- (1) large bowl with 1000 ml of hep saline
- (4) HP stock cocks
- (1) 84" tubing
- (1) bowl with 15 ml of contrast (not 30!)
- (2) 60 ml syringes
- (1) 10 ml syringe
- (1) forcep/kelly
- (1) blade or scissor
- (1) tegaderm (pop tart size)
PROCEDURE
- Access obtained with u/s
- Need 20 and 60 cc flush on front table for the delivery system.
- (Possible) 8F 35cm LFV for transcutaneous pacing
- RFV Access
- Dilate with 8F
- Preclose
- Versacross Sheath inserted
- Versacross pigtail wire inserted
- Transeptal puncture, pigtail wire advanced
- Versacros sheath exchanged for 29F Delivery sheath over pigtail wire
- Pigtail advanced across the mitral valve and LV gram @ 15/45 performed
- Mitral annulus denoted on live monitor screen by Rep.
- 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
- Dock Delivery System (DDS) advanced through GS
- Dock deployed in a timely fashion ;)
- DDS removed and Pigtail inserted over exchange J for valve crossing
- J wire exchanged for Safari 2
- Pigtail and GS 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 if accessed
- 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
