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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. |
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Section K:
seq# 1630-1880 |
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2.
To review an individual Seq# clinical question, click on the Seq# title
below. 1280 OpCAB
3090-3180 Section R. 3. CC/TM: Corrections/Clarifications to Training
Manual |
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NEW |
Date |
SeqNo |
FieldName |
Definition |
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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 |
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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) |
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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. |
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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. |
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. |
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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. |
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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 |
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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). |
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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. |
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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. |
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NEW! |
1640 |
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 |
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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 |
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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. |
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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). |
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NEW! |
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. |
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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 |
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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. |
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1/05 |
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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 |
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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 |
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1690 |
VS-Aortic Proc-Imp |
Indicate the name of the prosthesis implanted. |
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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
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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. |
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1700 |
VS-Aortic Proc-Imp-Size |
Indicate the Aortic implant size. |
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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 |
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1750 |
VS-Mitral Proc-Imp |
Indicate the name of the prosthesis implanted. |
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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. |
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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. |
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1760 |
VS-Mitral Proc-Imp-Size |
Indicate the Mitral implant size. |
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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 |
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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. |
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1810 |
VS-Tricuspid Proc-Imp |
Indicate the name of the prosthesis implanted. |
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1820 |
VS-Tricuspid Proc-Imp-Size |
Indicate the Tricuspid implant size. |
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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 |
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1870 |
VS-Pulmonic Proc-Imp |
Indicate the name of the prosthesis implanted. |
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1880 |
VS-Pulmonic Proc-Imp-Size |
Indicate the Pulmonic implant size. |
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