PPVI (PERCUTANEOUS PULMONARY VALVE IMPLANTATION)

under General Anaesthetic

BiPlane views

Scrub (SMALL) TROLLEY:

1 Barts TAVI pack

1 10F Femoral Sheath

1 5F JR4 Catheter

1 6F Pigtail catheter

1 Multi-track catheter

1 PTS-X sizing balloon (ask for size)

1 12Fr Mullins Sheath 75cm length or 12F Mullins 85cm

1 BIB balloon (ask for size)

1 AndraStentXL or Covered CP stent (ask for size)

1 26Fr Gore Dryseal sheath (65cm length)

2 Proglide

1 J-tip Terumo 260cm guidewire

1 Lunderquist wire

20ml 1% Lidocaine

20ml 0.5% Bupivacaine

10ml Heparin

1:1000 Adrenaline

If needs stenting,

1 BIB balloon (75ml:25ml saline:contrast mixture)

Orange- outer balloon - 20mL

Indigo-inner balloon - 10mL

Cyan - catheter - flushing

2 3-way tap

3 10ml luerlock syringe

1 20ml luerlock syringe

BIG TROLLEY (VALVE CRIMPING): (inverted orientation. Skirt towards RV)

*valve to be crimped on the balloon directly, with only medium force applied on the crimper

3-way tap

60mL luerlock syringe (for de-airing)

30mL luerlock syringe (for flushing)

Contrast 15mL/Saline 85mL

A pair of Scissor and forceps (borrow from small trolley)

2 Bowls of Saline for soaking valve (minimum of 1 minute each bowl)

Procedure:

Right femoral venous puncture

6F -> 10F femoral sheath with Proglide

6F MPA1 diagnostic catheter with 260cm guidewire

Insert wire up to distal pulmonary artery

6F Multitrack catheter

Exchange 10F femoral sheath with 12F 75cm Mullins sheath

Insert sizing balloon up to pulmonary stenosis and dilate

Mount AndraStentXL to BIB balloon and deploy in the stenotic area

Exchange Mullins sheath with Gore Dryseal sheath

Insert Edwards valve and deploy slowly

Insert Multitrack catheter to measure changes

Close access using Proglide