Welcome to the STS ACC TVT Registry August 22 case scenario. This month we will review metric 307, patients with acceptable quality of life outcome at 30 days based on KCCQ summary score. 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 which returned 500 milliliters of blood. However, despite other attempts to stabilize the patient, the patient ultimately expired on the procedure table. As a data analyst, would you expect this patient to be in the denominator? 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. Per the 30-day follow-up Executive Summary Measures and Metrics Companion Guide, patients with TAVR comprise the denominator. There are no denominator exceptions. Additionally, the only denominator exclusions are records where the indexed TAVR procedure was aborted, the lab visit was not the first TAVR visit, and where the patient was enrolled in an NCDR ACC research study where a study device was used. Therefore, patients who are deceased at discharge meet denominator and are evaluated. So you may be asking yourself, but since the patient was deceased at discharge, I cannot do a follow-up on them, nor can I perform a follow-up KCCQ. So why are they included? Well, that boils down to the purpose of the metric. The purpose of the metric is to inform sites which patients are considered alive and well since their procedure. In other words, the metric first scans for patients who are alive at their 30-day follow-up. If a patient is deceased prior to their follow-up, they are not alive nor well and will not meet the numerator. Only then, if identified as alive, will the metric scan for other numerator criteria that identifies them as well, which includes the KCCQ. The metric is not tracking KCCQ performance. It only reviews the KCCQ results, if available, to determine if the alive patient is considered well. Thank you for viewing the August 2022 STS-ACC TBT Registry Case Scenario. See you next month!

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STS ACC TVT Registry

aortic stenosis

transcatheter aortic valve replacement

paravalvular leak