0422 - Metric 4 | Proportion of Left Atrial Appendage Occlusion Procedures Successful-0422 - Metric 4 | Proportion of Left Atrial Appendage Occlusion Procedures Successful

Video Transcription

Thank you for joining us for the April 2022 LAAO Registry Case Scenario. Today, we will be discussing Metric 4, Proportion of Left Atrial Appendage Occlusion Procedures Successful.  A 67-year-old female presents for an LAAO procedure with a CHADS VASc2 score of 4, hypertension, diabetes, TIA, and thromboembolic risk.  A 24-millimeter Watchman device was coded as deployed and released in sequence number 7290.  The procedure was neither canceled nor aborted, but the device margin residual leak was not  assessed by echocardiogram post-device release and coded as not assessed in sequence 7306. Our question, would this patient appear in the numerator for Metric 4, Proportion of  Left Atrial Appendage Occlusion Procedures Successful? Number one, no. Or number two, yes.  Please take a few moments to review the documentation and the question prior to determining your response.  Would the patient appear in the numerator for Metric 4, Proportion of Left Atrial Appendage Occlusion Procedures Successful? The answer is no.  When the patient does not have the device margin residual leak by echocardiogram after device release and the sequence is coded as not assessed or left blank, they will not  be included in the numerator for Metric 4. This screenshot comes from the Outcomes Companion Guide and shows the numerator inclusion for Metric 4.  We know from the documentation that the patient did not have a canceled or an aborted procedure.  The patient did not convert to open heart surgery and the device was coded as deployed released. The only missing piece is that device margin residual leak was not assessed.  Therefore, the numerator inclusion criteria is not met and the patient would appear in the denominator but not the numerator for Metric 4.  For the bonus question, we are keeping the same basic information, but in this scenario,  the patient did have their device margin residual leak assessed and documented as 7.5 millimeters. Would the patient meet the criteria for inclusion in the numerator for Metric 4?  Using the same documentation, we know that the patient did not have a canceled or an aborted procedure.  The patient did not convert to open heart surgery and the device was coded as deployed released.  The device margin residual leak was assessed in this scenario, but the result was a leak of 7.5 millimeters, which does not meet the numerator inclusion criteria.  In order to meet the numerator, the residual leak at the device margin would have to measure 5 millimeters or less.  Again, the patient would appear in the denominator but not the numerator for Metric 4. Thank you for viewing the LAAO Registry Case Scenario for April of 2022.  We'll see you next month.

Video Summary

In the April 2022 LAAO Registry Case Scenario, Metric 4, which measures the proportion of successful left atrial appendage occlusion (LAAO) procedures, is discussed. The case involves a 67-year-old female with multiple risk factors and a CHADS VASc2 score of 4. During the procedure, a Watchman device was deployed and released, but the residual leak was not assessed by echocardiogram. The question posed is whether this patient would be included in the numerator (successful procedures) or denominator (total procedures) for Metric 4. The answer is no, as the patient did not meet the criteria for inclusion in the numerator due to the unassessed residual leak. In a bonus scenario where the leak was assessed but measured 7.5 millimeters, the patient still would not meet the criteria for inclusion in the numerator. The video concludes by thanking viewers and announcing the next session's date.

Keywords

LAAO Registry

Metric 4

left atrial appendage occlusion

Watchman device

residual leak