Frequently Asked Questions - 1st DRAFT

 

The Society of Thoracic Surgeons

 

Frequently Asked Questions: Adult Cardiac Surgery Database

 

Version 2.52.1

 

 August, 2006

 

 

How to use the “interactive” FAQ Document:

 

1.  To review all clinical questions in an individual section, click on the section title below.

 

Section A:  seq# 40-80

Section F:  seq# 750-870

Section K:  seq# 1630-1880

Section P:  seq# 2710-3010

Section B:  seq# 100-210

Section G:  seq# 890-1040

Section L:  seq# 1920-2350

Section Q:  seq# 3020-3080

Section C:  seq# 220-340

Section H:  seq# 1050-1200

Section M:  seq# 2360-2560

Section R:  seq# 3090-3210

Section D:  seq# 350-550

Section I:  seq# 1210-1500

Section N:  seq# 2570-2600

Section S:  seq# 3220-3240

Section E:  seq# 560-670

Section J:  seq# 1520-1620

Section O:  seq# 2610-2700

 

 

2.      To review an individual Seq# clinical question, click on the Seq# title below.

 

310 ICUInHrs                                   2470 OCarAFib

340 TotHrICU                                  2560 OCarOthr

440 RenFail                                     2710 Complics                                                            

490 InfEndo                                     2750 COpReOth                                                         

850 ArrhyTyp                                   2780 CISternDeep

1050 NumDisV                                2830 CNStrokP

1260 EmergRsn                              2950 COtCoag

1280 OpCAB                                    3090-3180 Section R.

1310 OpOCard                                3220 Readm30

1380 PerfusTm                                3240 ReadmPro

1410 XClampTm

1640 OpMitral

1650 OpTricus

 

3.  CC/TM:  Corrections/Clarifications to Training Manual

 

NEW

Date

SeqNo

FieldName

Definition

 

 

1630

VS-Aortic Proc-Procedure

Indicate whether a surgical procedure was done or not done on the Aortic Valve.  Select one of the following:

a. No

b. Replacement

c. Repair/Reconstruction

d. Root Reconstruction with Valve Conduit

e. Replacement + aortic graft conduit (not a valve conduit)

f. Root Reconstruction w/ Valve Sparing

g. Resuspension Aortic Valve with replacement of ascending Aorta

h. Resuspension Aortic Valve without replacement of ascending Aorta

i.  Resection Sub-Aortic Stenosis

 

01/06

I am reviewing a patient who recently underwent a Homograft Bentall procedure. I am unsure how I should code this for sequence #'s 1630 and 1680. A homograft aortic valve (24mm) was used.

Bentall Procedure with a Homograft Valved Conduit would be coded as Seq# 1630 OpAortic = Root Reconstruction w/ Valve Conduit and Seq# 1680 VSAoImTy = H (Homograft)

CC/TM

2/05

Procedures F- I in the Data Field Intent/Clarification section of the Training Manual, for seq# 1630, VS-Aortic Proc-Procedure, should read: 

 

#1630: F: Root reconstruction with Valve sparing: 

The Aortic root is reconstructed/replaced, typically secondary to aortic dissection, while the native aortic valve is left intact.  The root is typically reconstructed utilizing a conduit or type of prosthetic material.

*ascending aorta reconstructed/replaced

*native aortic valve left intact

 

#1630: G:  Resuspension aortic valve with replacement of ascending aorta:

The native aortic valve is grossly anatomically normal but because of a diseased ascending aorta (most often due to a type II aortic aneurysm) aortic insufficiency/regurgitation is created.  The Ascending aorta is replaced with a graft conduit.  The aortic valve is excised and re-suspended (re-sutured) in such a way as to create a more normal shape thereby reducing the insufficiency/regurgitation.

*Native ascending aorta reconstructed/replaced

*Native aortic valve excised and re-suspended (re-sutured) in original position

 

#1630: H:  Resuspension aortic valve without replacement of ascending aorta:

The native aortic valve is grossly anatomically normal.  The native ascending aorta is grossly anatomically normal.  Obstruction of flow through the aortic valve has been created due to an overgrowth (hypertrophied) of the sub aortic fibrous membrane.  The native aortic valve is excised and re-suspended (re-sutured) to allow for the excising of the overgrowth or excess fibrous membrane.  Surgical intervention is required when either the growth of the membrane invades the aortic valve structure or when the growth inhibits the hemodynamic flow and creates significant increase in flow gradients across the aortic valve and/or significantly increases the pressure load on the left ventricle.

*Native ascending aorta left intact

*Native aortic valve excised and sutured/re-suspended

*Obstructive growth/object removed (sub-aortic fibrous member excised.  This procedure may be referred to as myectomy)

 

#1630: I:  Resection sub-aortic stenosis:

The fibrous membrane or muscle under the aortic valve hypertrophied/enlarged to cause obstruction of flow through the aortic valve and/or increased left intra-ventricular pressures causing hemodynamic compromise.  Surgical intervention requires the removal/excision of this mass/membrane to relieve the intra-ventricular pressures and/or reduce the valve gradient flows to more normal levels. 

*ascending aorta remains intact. 

*The native aortic valve remains intact.

* Sub-aortic fibrous member excised which may or may not involve a portion of the septal muscle.  This procedure is often referred to as myectomy.

 

3/06

1)I have a pt who had a freestyle aortic mini-root heart valve (valve plus aortic root) as well as an aortic graft conduit.  This combination does not really fit into the categories provided.  I suppose I could pick "replacement + aortic graft conduit" although it is not a straight valve replacement but a mini-root.  I'd have the same question is this were a homograft root replacement (cadaver valve with root) plus an aortic graft conduit.  Please let me know how to code. 

2) When I have a clear-cut valve replacement + aortic graft conduit I pick that category under #1650.  I also code #2520 "yes" in part M.  Is this correct or does this duplicate data?

1) Code as Aortic Valve Replacement + Aortic Graft Conduit. It sounds like a freestyle valve that is housed in a short root that does not require reimplantation of the coronaries and does not require replacement of the ascending aorta but rather supplies the operator with conduit to support the aorta.
2) If the surgery was a Tricuspid Replacement and aortic graft conduit, code Seq#1650 OpTricus as Replacement and Seq#2520 ONCAoAn as Yes. There is no duplication of data. 2 separate procedures were performed during the same setting. However, if the surgery was an Aortic Valve Replacement + Aortic graft conduit, code Seq#1630 OpAortic as Aortic Valve Replacement + Aort graft conduit.

 

3/06

Patinet has a growth (fibroelastoma) removed from the aortic valve.  It was a stalk with finger-like projections that was anchored on the valve.  It was resected.  This was the only work done.  Is this a cardiac other or a aortic valve repair?  Thanks

If the valve had to be reshaped or there was some work done to the annulus, it would be a valve repair. If the valve was debrided with no reshaping of the leaflets or annulus, code it as an other cardiac.

 

 

1640

VS-Mitral Proc-Procedure

Indicate whether a surgical procedure was done or not done on the Mitral Valve.  Select one of the following:

a. No

b. Annuloplasty only

c. Replacement

d. Reconstruction with Annuloplasty

e. Reconstruction without Annuloplasty

CC/TM

4/05

Procedures B, D, and E  in the Data Field Intent/Clarification section of the Training Manual, for seq# 1640, VS-Mitral Proc-Procedure, should read: 

 

#1640: B: Annuloplasty only:  The mitral annulus (area around the valve) is reconstructed to more normal geometry maintaining as much leaflet and sub-valvular structure as possible.  The reconstruction is supported with or without a suture, band or ring. 

 

#1640: D: Reconstruction with annuloplasty:  A reconstructive procedure is done to the valve itself (the leaflets of the valve and/or to the cordea), and another procedure is done to the mitral annulus (area around the valve).  See annuloplasty definition above.

 

#1640: E: Reconstruction without annuloplasty:  A reconstructive procedure is done to the valve itself (the leaflets of the valve and/or to the cordea).  There is no procedure done to the mitral annulus (area around the valve). 

 

1/06

How do I code for mitral valve commisurotomy and tricuspid valve repair?

A mitral commisurotomy is a type of valve repair. The leaflets which have fused together at their "commissures" (points of touching) are separated by the surgeon. A mitral commisurotomy and tricuspid repair would be coded as Seq# 1640 OpMitral = Reconstruction w/ Annuloplasty or Reconstruction w/out Annuloplasty, depending on if the annulus was repaired and Seq# 1650 OpTricus = Reconstruction w/ Annuloplasty or Reconstruction w/out Annuloplasty, depending on if the annulus was repaired.

 

3/06

CABG with mitral commissurotomy. Not sure where to identify the commissurotomy?

Commisurotomy = MV Repair. Code this in Seq# 1640 OpMitral as either Reconstruction w/ Annuloplasty or Reconstruction w/out Annuloplasty depending on if the mitral valve annulus was repaired or not.

NEW!

08/06

1640
  Short Field Name: VS-Mitral Proc-Procedure
  Message: How should I code the repair of a perivalvular leak around a previously placed prosthetic valve? The native valve is not being repaired and the risk associated with these patients (who often have hemolytic anemia) is much different than the straightforward annuloplasty or reconstruction of a native valve.  I do not believe they should be grouped with choices B,D, or E because the patient's native valve is not being repaired, but no new implant is going in to choose C? Thanks for your guidance.

While there is not an ideal answer for this patient, the patient should be included in your valve population and perhaps the most correct choice is reconstruction without annuloplasty

 

 

1650

VS-Tricuspid Proc-Procedure

Indicate whether a surgical procedure was done or not done on the Tricuspid Valve.  Select one of the following:

a. No

b. Annuloplasty Only

c. Replacement

d. Reconstruction with Annuloplasty

e. Reconstruction without Annuloplasty

f. Valvectomy

 

4/05

The surgeon did a De Vega procedure on the tricuspid valve. Would this procedure be captured under “annuloplasty only” or “reconstruction with annuloplasty?”

A. DeVega procedure should be capture as "Annuloplasty Only."

When a DeVega procedure is done a suture is run around the annulus like a purse string, sometimes twice.  A valve sizer is inserted into the annulus and the purse string is cinched down to fit snuggly around the sizer.  A ring or band then may be inserted to support the annulus.  No real reconstruction is done to the valve itself. 

CC/TM

4/05

Procedures B, D, and E  in the Data Field Intent/Clarification section of the Training Manual, for seq# 1650, VS-Tricuspid Proc-Procedure, should read: 

 

#1640: B: Annuloplasty only:  The tricuspid annulus (area around the valve) is reconstructed to more normal geometry maintaining as much leaflet and sub-valvular structure as possible.  The reconstruction is supported with or without a suture, band or ring. 

 

#1640: D: Reconstruction with annuloplasty:  A reconstructive procedure is done to the valve itself (the leaflets of the valve and/or to the cordea), and another procedure is done to the tricuspid annulus (area around the valve).  See annuloplasty definition above.

 

#1640: E: Reconstruction without annuloplasty:  A reconstructive procedure is done to the valve itself (the leaflets of the valve and/or to the cordea).  There is no procedure done to the tricuspid annulus (area around the valve). 

NEW!

08/06

When a Cardiac Transplant is done, our surgeon always does a tricuspid annuloplasty to the doner heart and states that this is automatically done so that everything attaches correctly. Do I capture this sepatately or is this automatically assumed to have taken place with a translant?

Yes, capture as part of the initial procedure; Tricuspid annuloplasty and Implant type.

 

 

1660

VS-Pulmonic Proc-Procedure

Indicate whether a surgical procedure was done or not done on the Pulmonic Valve.  Select one of the following:

a. No

b. Replacement

c. Reconstruction

 

 

1670

VS-Aortic Proc-Aortic Annular enlargement

Indicate whether an annular enlargement procedure was performed on the aortic valve.  Anaortic annular enlargement is defined as incision of the aortic annulus to enlarge the aortic orifice.  Annular enlargement techniques, include but are not limited to Manouguian, Konno and Nicks.

 

1/05

 

Seq# 1680-1880, Valve Key

How would I code the following model numbers for the Carpentier-Edwards PERIMONT valves?

 

Model # 6900P

Model # 2700

Model # 2800

Model # 3000

1.  Model 6900P is the Carpentier-Edwards PERIMONT Plus.  This valve is for mitral valve replacement only.  When using this model # code as 777 = Other

 

2.  Model 2700 is the Carpentier-Edwards PERIMONT Pericardial Aortic Bioprosthesis.  B6 on the valve key

 

3.  Model 2800 is the Carpentier-Edwards PERIMONT Pericardial Aortic RSR (Reduced Sewing Ring) Bioprosthesis.  Code as 777 = Other

 

4.  Model 3000 is the Carpentier-Edwards PERIMONT MAGNA Pericardial Aortic Bioprosthesis.  Code as 777 = Other

 

 

1680

VS-Aortic Proc-Imp-Type

Indicate the type of implant; choose one:

None

M = Mechanical

B = Bioprosthesis

H = Homograft

A = Autograft

R = Ring/Annuloplasty

BA = Band/Annuloplasty

 

 

1690

VS-Aortic Proc-Imp

Indicate the name of the prosthesis implanted.

 

4/04

Is this prosthesis listed in the valve key?  I took the information off the manufacturer's label. 

 

Edwards Lifesciences

Pericardial Tissue Valve

Model 3000

AKA: Bovine Magna Valve

Other Descriptors: Supra-anular & Scalloped

FYI:  This is not B6

 

 

According to the rep at Edwards Lifesciences: 

 

"...the PERIMOUNT Magna aortic bioprosthesis was approved by FDA in November of 2003.  It is a pericardial tissue valve, and has a scallop design for the supra-annular position."

 

Due to the date of the FDA approval, this valve would not have been included in the Valve Key for version 2.52.  I concluded updating the Valve Key by late summer of 2003.  Therefore, code as other - 777.  I will take note of this so that this valve can be included in the next specification upgrade.

 

 

1700

VS-Aortic Proc-Imp-Size

Indicate the Aortic implant size.

 

 

1740

VS-Mitral Proc-Imp-Type

Indicate the type of implant; choose one:

None

M = Mechanical

B = Bioprosthesis

H = Homograft

A = Autograft

R = Ring/Annuloplasty

BA = Band/Annuloplasty

 

 

1750

VS-Mitral Proc-Imp

Indicate the name of the prosthesis implanted.

 

11/04

My surgeon repaired a mitral valve with a Colvin-Galloway ring-annuloplasty.   Under the options available in the Valve Key, I do not see this as an option.  Is there another one that fits the bill? 

 

After speaking with a Medtronic representative, she states that they do not manufacture a Colvin-Galloway ring-annuloplasty.  The only Colvin-Galloway prosthesis that Medtronic produces is a Colvin-Galloway band.  She also states that there is consistent industry confusion in regards to bands and rings.

 

A "ring" is a "full ring" like a piece of jewelry.  The ring is sewn into the annulus of the patient's valve area & the ring provides support to the otherwise dysfunctional valve.  The "bands" are similar to "rings" in material & structure, but they are in the shape of a "C" or "U" - not a closed system.  Many surgeons prefer a band to a ring, since it provides ample support to the leaflets & repair the valve sufficiently without placing sutures through the entire circumference of the patient's annulus.  

 

Usually, the ring is used to help the posterior & anterior aspects of the valve coapt or merge - without the assistance of a device the leaflets of the valve generally are not coapting properly.  The variety of sizes & rigidity of both the rings & bands are usually a function of the patient's disease state - is the valve degenerative, rheumatic, ischemic (etc.) - some surgeons only use a stiff or "semi-rigid" device & some maintain that a softer, "flexible" device will provide enough support & hence a positive outcome.

 

11/04

1.  What is the correct way to capture the Cosgrove-Edwards Annuloplasty Band model # 4600, in the Valve Key?  According to Edwards, model # 4600 is the Cosgrove - Edwards Annuloplasty System.  On the valve key it lists Cosgrove-Edwards Annuloplasty System Ring.  The sticker that comes with model #4600 calls the prosthesis a band, so our perfusionists collects model #4600 as “Other = 777.”  What is the correct way to collect Cosgrove-Edwards Annuloplasty Band model # 4600?

2.  Also under Rings in the Valve Key is the Edwards MC3 Tricuspid Annuloplasty system G Future Band.  Is this a ring or a band?

According to an Edwards representative:

1.  Edwards refers to model #4600 as the Cosgrove - Edwards Annuloplasty System, and though it is in the shape of a band, it is a ring and should be listed and collected as such. 

2.  The Edwards MC3 Tricuspid Annuloplasty System, model # 4900, is also a ring.  The language "G Future Band" at the end of R11 on the Valve Key is incorrect language and is not associated with this valve. 

 

 

1760

VS-Mitral Proc-Imp-Size

Indicate the Mitral implant size.

 

 

1800

VS-Tricuspid Proc-Imp-Type

Indicate the type of implant; choose one:

None

M = Mechanical

B = Bioprosthesis

H = Homograft

A = Autograft

R = Ring/Annuloplasty

BA = Band/Annuloplasty

From version 2.41

7/03

What is the correct way to enter implant type for a DeVega Annuloplasty? Since it is a suture Annuloplasty there isn't really an implant. I have been entering the implant as none but we have differences in opinion so would like your help.

You are correct to enter the implant type as "none" for a DeVega Annuloplasty.

 

 

1810

VS-Tricuspid Proc-Imp

Indicate the name of the prosthesis implanted.

 

 

1820

VS-Tricuspid Proc-Imp-Size

Indicate the Tricuspid implant size.

 

 

1860

VS-Pulmonic Proc-Imp-Type

Indicate the type of implant; choose one:

None

M = Mechanical

B = Bioprosthesis

H = Homograft

A = Autograft

R = Ring/Annuloplasty

BA = Band/Annuloplasty

 

 

1870

VS-Pulmonic Proc-Imp

Indicate the name of the prosthesis implanted.

 

 

1880

VS-Pulmonic Proc-Imp-Size

Indicate the Pulmonic implant size.