Thank you for viewing the LAAO Registry Monthly Case Scenario for June of 2021. We will be discussing follow-up event device migration and device systemic embolism in sequence number 13165. This data element number has been changed to sequence number 14948 to reflect the new version 1.4. Our patient Mr. Oliver is admitted for an LAA occlusion procedure. The procedure is successful with a 27-millimeter Watchman device being implanted. Mr. Oliver was discharged the day after the procedure. A TEE was performed a week prior to the planned office visit for his 45-day follow-up. During the TEE, the Watchman device was noted to have dislodged from the left atrial appendage and was located in the left ventricle at the aortic root. Mr. Oliver was immediately transferred to the hospital and underwent a successful cardiac surgery in which the Watchman was retrieved and the left atrial appendage was surgically ligated. When capturing the patient's 45-day follow-up based on the documentation of the dislodgement of the Watchman device, which follow-up event should be coded? Number one, device migration, or number two, device systemic embolism? Please take a few moments to review the documentation and question to determine the best answer. The answer is number two, device systemic embolism. For the purpose of the LAAO registry, based on the registry's adverse event definition document, device systemic embolism will be coded if the device, in this case the Watchman, becomes displaced from its initial annular implantation site. The device is no longer in its original position and has navigated to or past the aortic root and or ascending or descending aorta. Mr. Oliver is seen in the implanting provider's office post-surgery a week after being discharged from the hospital. This office visit assessment and the date of the visit are being used to code the patient's 45-day follow-up. When coding Mr. Oliver's 45-day follow-up, these are all the events that meet requirements to be coded. LAAO occlusion reintervention, as an LAAO intervention, open or percutaneous, has occurred subsequent to the reference LAAO procedure and was unplanned at the time of the index LAAO procedure. Unplanned cardiac surgery, since the open cardiac surgery the patient underwent is directly related to the index LAAO procedure. Device explant, as the original LAAO device implanted was explanted. Device-related readmission, as the admission for the cardiac surgery was directly related to the original device implanted. And device systemic embolism, as the device became displaced from its original implantation site and navigated to the aortic root. This 45-day follow-up will be the last follow-up needed for Mr. Oliver, as the original device implanted was explanted prior to his 45-day follow-up assessment. One additional note to remember, if the assessment date being used for the 45-day follow-up, as in this case, is after the device removal, the device removal event will be coded in the same 45-day follow-up and therefore the patient will not require another follow-up after the 45-day follow-up. The same rule is applied to all follow-ups. For example, the patient has an explant of their Watchman device one month after their 45-day follow-up. The explant will be captured at the six-month follow-up and no other follow-up will be needed. Thank you for viewing the LAAO Registries Case Scenario for June of 2021.

LAAO Registry

Watchman device

device dislodgment

cardiac surgery

device systemic embolism