Section L

Scenario	Incidence (no previous incidence) Seq# 560	Previous CV intervention Seq# 570	Previous other: Intrap or Great Vessel, seq# 620	VAD, yes or no. seq#1300	Cardiac Tx and Tx date Seq# 2090, 2100	Other Cardiac Other: Cardiac Tx, seq# 2440	ReOp for Other Cardiac, seq# 2750
VAD + Transplant in one hospitalization	VAD primary procedure = first CV surgery	No	n/a	yes	Populate	n/a	Yes, to capture transplant
Isolated VAD	VAD primary procedure = first cCV surgery	No	n/a	yes	n/a	n/a	n/a
Isolated Transplant with VAD in place (isolated VAD implant and the isolated cardiac transplant were performed at separate hospitalizations.	Cardiac transplant = First Re-Op	yes	yes	no	n/a	yes	n/a

4/05

A consistency edit was in place that would check to see that the VAD Explant date field was between the admission date and discharge date. With this consistency edit in place, sites were given a warning in their Data Quality Report if the explant date entered was after the discharge date. Sites stated that it was important to be able to capture explant data via the Data Collection Form, even if, for example, the explant didn't occur until after the patient was discharged (i.e., the same patient readmitted at a later date for an isolated cardiac transplant). To allow for the capture of the explant information via the Data Collection Form, the consistency edit has been changed to allow explant dates to be after the discharge date for those records that have seq# 2350, VAD Status captured as With VAD.

1920

VAD-Previous VAD

Indicate if the patient, during a previous hospitalization, received a mechanical

ventricular assist device, pneumatically or electrically controlled, that supports the pumping chambers of the heart.

1930

VAD-Indication for initial VAD

Indicate the reason the patient is receiving the initial ventricular assist device (VAD)

- Bridge to Transplantation: Includes those patients who are supported with a VAD until a heart transplant is possible.

- Bridge to Recovery: Includes those patients who are expected to have ventricular recovery. (i.e. Myocarditis patients, postcardiotomy syndromes, viral cardiomyopathies, AMI w/ revascularization, and post-transplant reperfusion injury).

- Destination: Includes those patients where a heart transplant is not an option. The VAD is placed for permanent life sustaining support.

- Postcardiotomy Ventricular failure (Separation from CPB): Includes those

Postcardiotomy patients who receive a VAD because of failure to separate from the heart-lung machine. Postcardiotomy refers to those patients with the inability to wean from cardiopulmonary bypass secondary to left, right, or biventricular failure.

-Device Malfunction: Include those patients who are currently VAD supported and are experiencing device failure.

1940

VAD-Intubated Pre-VAD

Indicate if the patient was intubated prior to the OR in which the VAD was placed.

11/04

If the patient had been intubated during the same hospital admission as the VAD, but was extubated days before the VAD procedure do we answer this yes or no? Are we to record yes if the patient is intubated at any time prior to the procedure - or just yes if intubated at the time of the procedure?

The intent is to capture those patients that are intubated at the time of the procedure. The rational behind this intent is to capture those patients that are more unstable entering the OR.

12/04

Seq# 1950-2020, VAD Hemodynamics

Is there a more specific timeframe for "prior to induction of anesthesia? Would values measured days, weeks or months prior be appropriate? We do not routinely measure these values prior to induction of anesthesia. How should we answer this question?

The definitions for these seq#s all include the following language, "...prior to the induction in the OR, or in an ICU immediately prior to the OR." Although "immediately" is still vague, either your patient is going to have these hemodynamic parameters recorded just prior to induction in the OR, or recorded in an ICU immediately prior to the OR. If not, leave the fields blank. Values measured days, weeks or months prior are not appropriate.

1/06

We have to submit data for the next harvest and wonder if you could answer this question: We recently had a patient that received a VAD. There are no values/numbers documented for pre-VAD hemodynamics including PCWP, CVP, PVR, and CI. These are required fields that require values between 1-50 to be entered. What do we enter if we have no documented values for these fields?

These fields are required in the sense that they are in the core data set and are harvested fields. However, the data specifications state that No Action will be taken for missing data. The record will be accepted for harvest with these fields blank. If there are no values documented for these fields, you have no choice but to leave them blank.

1950

VAD-Hemodynamics Pre-VAD-PCWP

Indicate the Pulmonary Capillary Wedge Pressure (PCWP) in mm/Hg as determined prior to induction in the OR, or in an ICU immediately prior to the OR.

8/04

If the VAD was placed intraoperatively and no hemodynamics were done prior to induction in the OR, or in the ICU prior to VAD insertion, do I leave the Hemodynamics Pre-VAD sequences blank?

Yes, leave the Hemodynamics Pre-VAD sequences blank. As stated on the Data Collection Form and in each of Hemodynamics Pre-VAD sequences definitions, "...prior to induction in the OR, or in an ICU immediately prior to OR." If the data does not exist from the specified times, you must leave blank.

1960

VAD-Hemodynamics Pre-VAD-CVP

Indicate the Central Venous Pressure (CVP) in mm/Hg prior to induction in the OR, or in an ICU immediately prior to the OR.

1970

VAD- Hemodynamics Pre-VAD-PVR

Indicate the Pulmonary Vascular Resistance (PVR) prior to induction in the OR, or in an ICU immediately prior to the OR. Please collect the value in woods units. If your institution reports PVR as dynes sec/cm5, please convert using the formula below.

1980

VAD- Hemodynamics Pre-VAD-CI

Indicate the Cardiac Index (CI) in L/(min x m2) prior to induction in the OR, or in an ICU immediately prior to the OR.

1990

VAD- Hemodynamics Pre-VAD-RVEF

Indicate the Right Ventricular Function prior to anesthesia induction in the OR and as close to time of the VAD implant as possible.

2000

VAD- Hemodynamics Pre-VAD-RVEF Method

Indicate the method the RV Function was obtained.

2010

VAD- Hemodynamics Pre-VAD-PVO2 Measured

Indicate whether the peak Pulmonary Vascular Resistance (Peak VO2) was measured prior to induction in the OR, or in an ICU immediately prior to the OR.

1/05

The definition above should read: Indicate whether the peak Oxygen Consumption (Peak VO2) was measured prior to induction in the OR, or in an ICU immediately prior to the OR.

2020

VAD-Hemodynamics Pre-VAD-PVO2

Indicate the peak Pulmonary Vascular Resistance (PeakVO2) in ml/kg/min prior to induction in the OR, or in an ICU immediately prior to the OR.

1/05

The definition above should read: Indicate the Peak Oxygen Consumption (Peak VO2) in ml/kg/min prior to induction in the OR, or in an ICU immediately prior to the OR.

2030

VAD-Implant Type

Indicate the initial type of VAD implanted.

2040

VAD-Product Type

Indicate the specific product implanted. Implant defined as physical placement of the VAD.

4/05

There is not a choice of Thoratec PVAD, only a choice for Thoratec IVAD. The IVAD was recently FDA approved. Most implants in 2004 were with the PVAD. Do I just code all of our Thoratec patients as Other for product type?

Thoratec PVAD should be captured under "Other." Thoratec IVAD should be captured under "Thoratec IVAD. Unfortunately, the Thoratec PVAD option can not be added as a harvest code option until the next version.

2050

VAD-Implant Date

Indicate the date the VAD was implanted.

2060

VAD-Explant

Indicate if the VAD was explanted. Explant is defined as physical removal of the VAD.

2070

VAD-Explant Date

Indicate the date the VAD was explanted.

2080

VAD-Explant Reason

Indicate the reason the VAD was explanted:

1. Cardiac Transplant- The VAD was explanted for Cardiac Transplant.

2. Recovery- The VAD was removed after cardiac recovery.

3. Device Transfer- The VAD was explanted in order to implant another assist device.

4. Device-Related Infection- An infection within the pump pocket, driveline, VAD Endocarditis, or other infection requiring explantation of the VAD. The body of the VAD has an active infection requiring removal to eliminate the infection. "Device-related infections" are defined as positive culture in the presence of leukocytosis, and /or fever requiring medical or surgical intervention.

5. Device Malfunction- The VAD pump itself is not functioning properly causing hemodynamic compromise, and/or requiring immediate intervention or VAD replacement.

12/04

When a VAD patient expires in the hospital with the VAD in place, what should the reason for explant be?

If the patient expires with the VAD in place, the VAD was never explanted. Therefore, seq# 2060 = no. Due to the parent/child relationship between seq# 2060 to seq# 2070 and 2080, you will not have to populate these fields.

2090

VAD-Cardiac Transplant

Indicate whether the patient received a cardiac transplant during this hospitalization.

2100

VAD-Cardiac Transplant Date

Indicate the date the patient received a cardiac transplant.

2110

VAD-Initial VAD Cannulation/Attach Site LVAD Inflow

Indicate the location of the LVAD inflow site as the left atrium (LA) or the left ventricle (LV). The LVAD inflow is defined as the anatomic location (left atrium or left ventricle) for the VAD cannula or conduit that provides the flow of blood from the heart to the VAD pump.

2120

VAD-Initial VAD Cannulation/Attach Site RVAD Inflow

Indicate the location of the RVAD inflow site as the right atrium (RA) or the right

ventricle (RV). The RVAD inflow is defined as the anatomic location (right atrium or right ventricle) for the VAD cannula or conduit that provides the flow of blood from the heart to the VAD pump.

2130

VAD-Implant Type #2

Indicate the second type of ventricular assist device implanted.

2140

VAD-Product Type #2

Indicate the specific product #2 implanted. Implant defined as physical placement of the VAD.

2150

VAD-Implant Date #2

Indicate the date the VAD #2 was implanted.

2160

VAD-Explant #2

Indicate if the VAD #2 was explanted. Explant is defined as physical removal of the VAD.

2170

VAD-Explant Date #2

Indicate the date the VAD #2 was explanted.

2180

VAD-Explant Reason #2

Indicate the reason the VAD #2 was explanted:

1. Cardiac Transplant- The VAD was explanted for Cardiac Transplant.

2. Recovery- The VAD was removed after cardiac recovery.

3. Device Transfer- The VAD was explanted in order to implant another assist device.

4. Device-Related Infection- An infection within the pump pocket, driveline, VAD Endocarditis, or other infection requiring explanation of the VAD. The body of the VAD has an active infection requiring removal to eliminate the infection. "Device-related infections" are defined as positive culture in the presence of leukocytosis, and /or fever requiring medical or surgical intervention.

5. Device Malfunction- The VAD pump itself is not functioning properly causing hemodynamic compromise, and/or requiring immediate intervention or VAD replacement.

2190

VAD-Cardiac Transplant #2

Indicate if the patient received a cardiac transplant during this hospitalization.

2200

VAD-Cardiac Transplant Date #2

Indicate the date the patient received a cardiac transplant.

2210

VAD-Implant Type #3

Indicate the third type of ventricular assist device implanted.

2220

VAD-Product Type #3

Indicate the specific product #3 implanted. Implant defined as physical placement of the VAD.

2230

VAD-Implant Date #3

Indicate the date the VAD #3 was implanted.

2240

VAD-Explant #3

Indicate if the VAD #3 was explanted. Explant is defined as physical removal of the VAD.

2250

VAD-Explant Date #3

Indicate the date the VAD #3 was explanted.

2260

VAD-Explant Reason #3

Indicate the reason the VAD #3 was explanted:

1. Cardiac Transplant- The VAD was explanted for Cardiac Transplant.

2. Recovery- The VAD was removed after cardiac recovery.

3. Device Transfer- The VAD was explanted in order to implant another assist device.

5. Device Malfunction- The VAD pump itself is not functioning properly causing hemodynamic compromise, and/or requiring immediate intervention or VAD replacement.

2270

VAD-Cardiac Transplant #3

Indicate if the patient received a cardiac transplant during this hospitalization.

2280

VAD-Cardiac Transplant Date #3

Indicate the date the patient received a cardiac transplant.

2290

VAD-Primary VAD Comp-Intracranial Bleed

Indicate if the patient had an intracranial bleed, confirmed by CT Scan or other diagnostic studies.

2300

VAD-Primary VAD Comp-Embolic Stroke

Indicate if the patient had embolic stroke caused by a blood clot, air embolus, or tissue, confirmed by CT Scan or other diagnostic studies.

2310

VAD-Primary VAD Comp-Driveline and/or cannula Infection

Indicate if the patient had a driveline and/or cannula infection. Driveline and/or cannula infection is defined as the presence of erythema, drainage, or purulence at the VAD connection site whether entering or exiting the body in association with leukocytosis and in the presence of positive culture.

2320

VAD-Primary VAD Comp-Pump Pocket Infection

Indicate if the patient had a pump pocket infection. A pump pocket infection is defined as a persistent drainage in the physical location of the pump, located preperitoneally or intra-abdominally with positive cultures from the pocket site.

2330

VAD-Primary VAD Comp-VAD Endocarditis

Indicate if the patient had VAD endocarditis. VAD endocarditis is defined as an infection of the blood contacting surface of the VAD device itself. This may include:

- internal surfaces;

- graft material;

- inflow/outflow valves of the VAD.

2340

VAD-Primary VAD Comp-Device Malfunction

Indicate if the pump itself is not functioning properly causing hemodynamic compromise, and/or requiring immediate intervention or VAD replacement.

2350

VAD-Discharge Status

Indicate the VAD status at discharge from the hospital.

11/04

Within the same hospitalization, the patient receives a VAD and expires. For this patient how would I code seq# 2350, VAD-Discharge Status, with VAD or without VAD?

The intent of this field is to capture if the patient was discharged home with a VAD in place. If the patient expires in the hospital with or without VAD in place, code seq# 2350 as without VAD.