Download - Positionnement de la valve
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Positionnement de la valve
Dominique Himbert
Hôpital Bichat, AP-HP
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The « Check List »
Hemodynamic condition Quality of pacing Position of the guide wire in the apex of LV Perpendicularity to the aortic plane Positioning Deployment
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« The 3 Cusps View »
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C-THVPerpendicular View
+ =
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Segmented Dyna CT
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The « Check List »
Hemodynamic condition Quality of pacing Position of the guide wire in the apex of LV Perpendicularity to the aortic plane Positioning Deployment
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Final Positioning ES
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Rapid pacing to Help Positioning
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Search for a Good Alignment
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C-THV Positioning
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C-THV RT Positioning
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CT overlay on live fluoroscopy
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2D TEE Guidance
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3D TEE Guidance
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ICE Guidance
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The « Check List »
Hemodynamic condition Quality of pacing Position of the guide wire in the apex of LV Perpendicularity to the aortic plane Positioning Deployment
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Pacing Protocol for Valve Deployment
Operator Sequence Verbal
Primary Operator “Pacemaker ready?”
Pacemaker Operator “Pacemaker ready.”
Primary Operator Valve in position “Pacemaker on”
Pacemaker Operator Initiate Pacing “Pacemaker on”
Secondary Operator Verify SBP < 50 mmHg and
Verify Pulse Pressure < 10 mmHg
Inflate “Inflating”
Hold for 3 seconds
Deflate “Deflating”
Primary Operator Balloon fully deflated “Pacemaker off”
Pacemaker Operator Turn pacemaker off “Pacemaker off”
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Deployment of ES Prosthesis
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Angiography during Deployment of ES Prosthesis
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Slow Deployment for « Valve in a Valve »
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Final Result
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3D TEE During Deployment
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Conclusions
Hemodynamic condition Quality of pacing Position of the guide wire in the apex of LV Perpendicularity to the aortic plane Positioning Deployment
The « Key to Success » is to have a well structured team who follow these steps
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Thank you!Thank you!
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Percutaneous Aortic Valve Implantation
Pacing of the right ventricle (200/min)
Cribier et al J Am Coll Cardiol 2006; 47: 1216
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Rapid Ventricular Pacing
1:1 capture, SBP of 50 mmHg or below , and pulse pressure < 10 mmHg.
220 bpm → 200 bpm → 180 bpm → 160 bpm
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New Systems for Navigation
and Positioning during TAVI