[[100 Welcome to Outlines of Technique in Cardiac Surgery]] # (DRAFT) Technical Outline of Transcatheter Aortic Valve Implantation ## Pre-Operative Steps - Pre-operative Image Analysis and Review - coronary heights - perimeter - diameter - sinus heights - access diameter - calcification - bifurcation - external iliac diameter - horizontality of aorta - preparation of lunderquist wire for horizontal aorta - Review Cusp Overlap angles - Creatinine - Confirm Transthoracic Windows - Check whether pre-existing effusion ## Access - RIJ Cordis - RIJ Transvenous Pacemaker - Pannus retraction system - BCFA Access - J-wire up Valve Access Arteriotomy - "Pre-Close" Perclose Preparation of Valve Access Arteriotomy - Amplatz catheter over J-wire - Exchange J-wire for Stiff Wire - Dilation of Valve Access Arteriotomy - Heparin Administration and ACT Check - Place Valve Access Arteriotomy Sheath over Stiff Wire - Remove introducer - Amplatz catheter over stiff wire into Aortic root - Exchange stiff wire for Glidewire ## Crossing Aortic Valve and Assessment - Cross Aortic Valve - Exchange Amplatz Catheter for Pigtail - Measure LVEDP - Consider Confirmation of Aortic Gradient - Consider Pre TAVI Balloon Aortic Valvuloplasty - Exchange LV Pigtail for Lunderquist wire - Inspect load of Corevalve - Exchange sheath for valve delivery system over Lunderquist wire - Guide delivery system over aortic arch under fluoroscopy - Bring up to aortic valve - Pigtail over J wire through utility femoral access into non-coronary sinus - Prepare for valve crossing - Parallax - Cusp overlap view ## Valve Deployment - Standby to pace - Cross valve - Depth of insertion - Contrast root shot - Begin deployment - Rapid ventricular pacing - 80% Deployment - Check with root shot - Check with echo - Dealing with a tilted valve - 100% Deployment - Withdrawal of delivery system into descending aorta - Re-capture of delivery system - Exchange of delivery system for sheath/introducer over Lunderquist wire ## Assessment of TAV and Treatment of Paravalvular Leak - J-wire to remove noncoronary sinus pigtail and reposition - Check with root shot - Check with echo - Decide on post TAVI BAV - Post TAVI BAV - Check post valve gradient ## Arteriotomy Closure - Prepare for dry seal closure - Dry seal closure of valve access arteriotomy - Completion angiogram - Perclose/Angioseal closure of utility access [[TAVR Op Note Template]] [[Guidewire Pacing for TAVI]] [[20220802 If a TAVR Slips up above the annulus]] [[Notes on Transapical Sapien 3 Implantation]] [[Rescue Plan for TAVR Disaster]]