[[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]]