[[450 Technical Outline of Transcatheter Aortic Valve Replacement]] # Notes on Transapical Sapien 3 Implantation Use sterile sleeve TTE to find apex, 5th or 6th Interspace Wound retractor Pericardial stays Two 3-0 MH big needle cannulation stitches Needle J wire Long 6french sheath JR2 catheter over J, use it to guide J wire into descending aorta. Superstiff wire down JR2 into descending aorta For 20, 23, 26 mm, 18F sheath For 29, 21 F Sheath Rotating knob can flex, but no pusher Twist sheath into LV, note markings for depth Remove introducer Pre dilate with BAV crimped valve goes down Other steps are the same Angiogram Adjust height Hold ventilation Start pacing Angiogram while slow inflation and while pigtail withdrawn Three seconds Deflate balloon Pacing off Remove system Leave wire Angiogram Remove sheath Cinch pursestrings Remove wire Tie down, just enough to stop bleeding Close pericardium with stays Pleural tube Close thoracotomy