Welcome to the STS-ACC TVT Registry June 2022 case scenario. This month, we will review sequence number 9002, intrapost procedure events occurred regarding cardiac perforation. An 87-year-old patient with severe aortic stenosis and severely calcified leaflets presented for elective TAVR. During his TAVR procedure and post-deployment, significant paravalvular leak was observed. The decision was made to perform balloon valvuloplasty, and immediately after, he became hypotensive with decreased respirations. Imaging revealed an annular rupture, thought to be from calcifications that extended into the ventricle. A pericardial drain was placed that returned 500 milliliters of blood. Our question is, how is sequence number 9002, intrapost procedure events occurred, coded for cardiac perforation? Number one, no, or number two, yes? Please take a few moments to review the documentation and the question prior to making a final selection. And the answer is number two, yes. Sequence number 9002 would be coded as yes for cardiac perforation. Per the data dictionary, a perforation of the myocardium, aortic annulus, or aorta, with or without tamponade associated with the perforation is captured in the data set. In this scenario, the documentation of annular rupture extending into the left ventricle indicates a perforation of the aortic annulus and myocardium occurred and meets the target value. Our follow-up question, is annular rupture also coded in sequence 9002 if it was already captured as a perforation? Please take a few moments prior to making your final selection. And the answer is yes. Sequence number 9002 would also capture yes for annular rupture as the data definition is met here too. To review, an annular rupture, or annulus rupture, is an umbrella term covering different procedural related injuries of the aortic root and the left ventricular outflow tract during catheter aortic valve replacement. What additional data elements would be captured in sequence number 9002 in this scenario? Please take a few moments to review the TAVR data collection form and documentation prior to making a final selection. And the answer is number one, bleeding other, as the patient experienced bleeding from a site not otherwise specified, in this case the pericardium, that required procedural intervention surgery, in this case a drain, at the bleeding site to reverse stop or correct the bleeding. Number two, cardiac surgery or intervention other unplanned, as the patient subsequently underwent cardiac surgery or a cath lab intervention, in this case a pericardial drain that was unplanned. And three, vascular complication major, as the patient experienced an annulus rupture, left ventricle perforation, meeting criteria number one of the definition. Thank you for viewing the June 2022 STS ACC TVT registry case scenario. We'll see you next month.

STS-ACC TVT Registry

case scenario

sequence number 9002

cardiac perforation

annular rupture