This is the IMPACT Registry June 2024 Case Scenario, Section N, Intra and Post-Procedure Events. A 20-year-old male presents with a history of coarctation of the aorta, pulmonary artery stenosis, truncus arteriosus repaired at infancy and surgical conduit replacement at 10 years of age, and presents with worsening dyspnea and fatigue. His thoracic echocardiogram shows mild to moderate pulmonary insufficiency, normal RV systolic function. An MRI demonstrates no branch pulmonary artery stenosis and the patient presents to the cath lab for a TPVR procedure. A left femoral access site is attempted but an occlusion is noted and the right femoral access site is used for the procedure. Pulmonary artery compression testing was performed with a 14mm balloon inflation and no compression is noted. Predilatation is performed utilizing multiple balloons due to the calcified homographed and VTAC is noted during wire manipulation which then ultimately resolves. There is angiographic evidence of conduit rupture and a large hemothorax. A covered stent is placed sealing the bleed, a chest tube is placed and the patient receives a cell saver blood transfusion. The valve is delivered with mild pulmonary valve regurgitation. While in the PACU the patient experiences bleeding from the left femoral access site with a growing hematoma. Direct manual pressure was applied and sandbags are also applied which stops the bleeding. An ultrasound is obtained which shows a pseudoaneurysm that is treated with a thrombin injection and the patient experiences a 3.3 gram drop in hemoglobin. The question we have is what intra and post procedure events will be captured for the registry? Please pause here and take a moment to review all the information on this slide before you make your decision. Arrhythmia, sequence number 8005, seeks to capture if the patient had an arrhythmia requiring treatment. In the given scenario, the arrhythmia did not require a treatment. Sequence number 8090, bleeding event, should be coded yes. The patient experienced a bleeding event that was observed and documented in the medical record that was associated with a greater than or equal to 3 grams per deciliter drop in hemoglobin. Sequence number 8095, bleeding event at access site, will be coded as no. Sequence number 8095 seeks to capture if the patient experienced significant external bleeding at the percutaneous entry site as coded in sequence number 5110, which is arterial access site. In the given scenario, the right femoral was the arterial access site for the procedure. Sequence number 8100, hematoma at access site, will be coded as no. Sequence number 8100 seeks to capture if the patient experienced a hematoma at the percutaneous entry site. In the given scenario, the right femoral was the arterial access site for the procedure and the hematoma occurs at the left femoral site. Sequence number 8125, other bleed, should be coded yes. Sequence number 8125 seeks to capture whether the patient experienced other bleeding not available for selection within the registry, for example, oral bleeding, bleeding from mechanical support device access site, etc., which was observed and documented in the medical record with evidence of a hemoglobin drop greater than or equal to 3 grams per deciliter or a blood transfusion or a procedural intervention or surgery at the bleeding site to reverse or stop or correct bleeding. In the given scenario, the hematoma at the left femoral access site will be captured as an other bleed as there is evidence of a greater than or equal to 3 gram per deciliter drop in hemoglobin. Sequence number 8130, red blood cell transfusion, should be coded no. Sequence number 8130 seeks to capture if there was a transfusion of either whole blood or packed red blood cells. In the given scenario, the cell saver transfusion is the patient's own blood, therefore, not captured by the registry. And finally, sequence number 8140, other vascular complications requiring treatment, should be coded no. In the given scenario, the pseudoaneurysm, which is treated with thrombin injection, occurs at the left femoral access site. Other vascular complications requiring treatment captures any other vascular complication at the percutaneous entry site as coded in sequence number 5110, arterial access site, which required treatment or intervention. Thank you for viewing the MPAC Registry Case Scenario for June 2024.

chest pain

shortness of breath

atrial septal defect repair

takotsubo cardiomyopathy

coronary angiography

TPVR procedure

complications

arrhythmia

covered stent

registry