Alta Valve

*** THIS IS A RESEARCH CASE ; EQUIPMENT WILL NOT SCAN, PLEASE KEEP BARCODES OF ALL NON-SCANNABLE EQUIPMENT FOR ROSALIE WITH A PATIENT LABEL ***

As of today 1/21/2025 we have done TWO of these procedures (on 3/29/2024 & 1/21/25). This page is rough draft and will be updated along the way.

Room Set Up ; 2 Manifolds needed for pressure, one with contrast incase of coronary angio. No Acist. Stabilizer 100cm from zyphoid notch. Rampart, yes if the deployment angles allow.

Supplies

• TAVI Pack
• Micropuncture
• 8Fr Pinnacle
• 6F Pinnacle
• 3 Perclose
• 24fr DrySeal -ASK BEFORE OPENING
• 6Fr Balloon wedge PA catheter
• VersaCross transeptal system
• 10mm Mustang for septostomy or a 14mm Armada
• Knu-Knit, Dermabond, Lido with EPI
• 0.035 x 260 J-tip wire
• (2) 5fr Pigtail catheters or 1 double lumen pigtail catheter (Langston)
• Alligator cables for OTW LV pacing
• Platinum Plus
• Stand support plate (example: plate used for MitraClip) placed under patient’s legs
• 2 transducer sets (RHC; AO/LV monitoring)
• 1 copilot for langston
• Implant and Delivery System Preparation -Back table
• (3) Sterile Bowls (1000ml or larger)
• 2L heparinized saline
• (4) Luer lock syringes (50ml or larger)
• (1) Pickup
• (2) Y-Tuohy Borst Sidearm Connector
• (2) High pressure 3-way Stopcock
• (1) Pressure bag
• Extra sterile gowns and gloves available for 4C team

Bail Out Equipment List

(List provided by Vendor)

• ECMO
• IABP
• Impella CP
• Blood transfusion ability
• Pacemaker interrogator if applicable per patient (for rapid pacing)
• Peripheral vascular balloons – over the wire, 0.035” wire compatible Septal Closure and PVL Instrument List
• Septal Closure Devices available – 2 per size: • Gore Cardioform PFO: 20mm, 25mm, 30mm • Abbott Amplatzer Cribaform: 18mm, 25mm, 30mm, 35mm • Corresponding delivery systems to match the above devices
• PVL plug devices available - (for example: Amplatzer ADO2 in these sizes: 4x6mm, 5x4mm, 5x6mm, 6x4mm, 6x6mm) Corresponding delivery systems to match the above devices (must be at least 80cm in length)
• 110cm Cook Ansel or Shuttle in both 4 French and 5 French

Procedural Steps:

• RFV access, pre-closed twice. 8Fr pinnacle advanced.
• LFA access, 6Fr pinnacle.
• Coronary angio?
• Insert langston to get AO/LV
• Place copilot on langston and advance Platinum Plus to LV, leave there to pace during deployment if needed. Leave black clip in connected, cover with towel.
• RHC. Expect PA sat for Fick CO/CI.
• Insert versacross curly wire to exchange 8F sheath for Versacross.
• Transeptal puncture.
• 8F Sheath reinserted to perform septostomy
• Vessel dilated with 22F long taper dilator
• Valve delivery advanced across the septum.
• Delivery aspiration with 2 60 cc syringe.
• "waterfall" wet to wet technique for valve advancement.
• Valve deployment
• Remove delivery system, keep delivery sheath in place
• Place 22F dilator INTO delivery sheath to use for 260 J-wire advancement
• Walk sheath and dilator out over J-wire and cinch both perclose devices and use knu-knit
• Lido with Epi given
• Perclose LFA