Thank you for reviewing the LAO Registry Monthly Case Scenario for August 2020. We will be discussing Sequence 7295, Aborted Procedures Relating to Metric 6, which measures the proportion of patients with a major complication either intra or post left atrial occlusion procedure and prior to discharge. We have documentation of a 70-year-old male patient who underwent a successful LAO procedure in which a Watchman device was attempted. During the attempt to deploy the device, the access system moved forward and perforated the left atrium. The perforation caused a pericardial effusion with tamponade that was confirmed by TEE. A pericardiocentesis was performed emergently but did little to stabilize the patient. With the bleeding not being able to be controlled, the LAO procedure was stopped and the patient was emergently transferred to the OR for an open cardiac surgery. Based on the documentation shared, will this procedure be coded as cancelled or aborted? Is number 1 cancelled or number 2 aborted? Please review the documentation and question to determine the best answer. We will give you a few seconds to review. The answer is number two, aborted. The procedure will be captured as an aborted procedure since the procedure was stopped after VENUS access had been established for the purpose of the LAAO procedure. A reminder and some additional information. If the procedure is stopped at any time between the patient entering the procedure room, which for the purpose of the registry is the procedure start time, and VENUS or epicardial access being obtained, that procedure will be classified as cancelled. If the procedure was stopped after VENUS or epicardial access was obtained, that procedure will be classified as aborted. Both cancelled and aborted procedures will be captured in the registry and will be followed for only the 45-day follow-up. However, if the procedure is cancelled prior to entering the procedure room, the procedure does not get captured in the registry and nothing has to be entered for the purpose of the registry. Additional documentation. The patient suffered a perforation of the left atrium causing a pericardial effusion with tamponade requiring open cardiac surgery. The procedure was stopped and the patient was emergently transferred to the OR. When abstracting the procedure, the procedure was coded as aborted in Sequence 7295 and the reason for the procedure being aborted was coded as decompensation in patient condition in Sequence 7296. Conversion to open heart surgery was also coded as yes with the reason coded as complication. Question 2. Based on the reason coded in Sequence 7296, will this patient be included in Metric 6, which measures the proportion of patients with a major complication either intra or post left atrial occlusion procedure and prior to discharge? Yes or No. Please review the documentation and question to determine the best answer. We will give you a few seconds to review. The answer is number one, yes. Based on Metric 6 numerator, if the reason coded for the procedure being aborted is one of the six listed, the patient will be included in the metric. The six reasons listed are device retrieval or open heart retrieval, which in the data collection tool, these choices are listed as transcatheter device retrieval and surgical device retrieval. Complication in patient condition. Thrombus developed during procedure, which in the data collection tool is displayed as device associated thrombus developed during procedure. Device related and unanticipated patient condition. If any of these choices are coded as the reason for the procedure being aborted, the patient will be included in the metrics numerator. All metric information regarding the rationale, numerator and denominator are available in the outcome report companion guide document for the in-hospital metrics, which are one through nine. To locate this document, select resources and then documents. Scroll down to user guide documents and download the outcome report companion guide. Thank you for viewing the LAO registries case scenario for August, 2020.

LAO Registry

aborted procedures

Metric 6

Watchman device

perforation

left atrial occlusion procedure

complication

aborted LAO procedure

major complications