Watchman
From Bay Area Structural Heart Wiki
WATCHMAN : LEFT ATRIAL APPENDAGE CLOSURE
Procedure Case Log
TIPS FOR STAFF
- Look up patient. Make sure Type & Screen completed prior to pickup.
- Cath Lab staff pick up patient
- Circulating RN initiate Anesthesia SIGN-IN/Time Out
- Anesthesia intubates patient & no longer placing arterial line. Give prophylaxis Ancef IV
- TEE performed. Procedure aborted if clot
- Prep patient & drape: Bilateral groin & bilateral clavicle to SUBZYPHOID
- Micropuncture ultrasound-guided RFV access
- 5 Fr Micropuncture sheath
- 150 cm J Wire
- 6 Fr Perclose pre-close RFV
- 8 Fr dilator
- 8.5 Fr SL 1 Sheath
- TEE & fluro guided transeptal access & images of Left Atrial Appendage
- Anesthesia gives Heparin IV. ACT GOAL >250-300
- Transeptal puncture with Large Curve C1 71cm Baylis Needle
- Measure LA pressure
- Straight 260cm Super Stiff Amplatz wire to LA
- SL1 exchanged out for 14 Fr WATCHMAN delivery sheath either SINGLE, DOUBLE or ANTERIOR Curve
- 6 Fr Str Pigtail to LAA. Angiogram of appendage
- Measure and select size of Watchman device
- Open and insert Watchman Device (Size: 21, 24, 27, 30, 33mm)
- 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
- Pull out pigtail & delivery guidecatheter
- Deploy Perclose Vein. SPIES: Hemostatic surgical suture. MD removes later.
- Patient disposition
- If device deployed → PACU → ICU Stepdown.
- If case cancelled →PACU → Post Op → Home
