Positionnement de la valve
description
Transcript of Positionnement de la valve
Positionnement de la valve
Dominique Himbert
Hôpital Bichat, AP-HP
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
« The 3 Cusps View »
C-THVPerpendicular View
+ =
Segmented Dyna CT
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
Final Positioning ES
Rapid pacing to Help Positioning
Search for a Good Alignment
C-THV Positioning
C-THV RT Positioning
CT overlay on live fluoroscopy
2D TEE Guidance
3D TEE Guidance
ICE Guidance
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
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”
Deployment of ES Prosthesis
Angiography during Deployment of ES Prosthesis
Slow Deployment for « Valve in a Valve »
Final Result
3D TEE During Deployment
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
Thank you!Thank you!
Percutaneous Aortic Valve Implantation
Pacing of the right ventricle (200/min)
Cribier et al J Am Coll Cardiol 2006; 47: 1216
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
New Systems for Navigation
and Positioning during TAVI