Welcome to our second educational opportunity for the STS-ACC TVT registry version 3 upgrade. In this learning activity we will address data elements that are common to TAVR procedures with an emphasis on new or updated data elements. Please note that a page number for the data dictionary has been included on each slide title for ease of locating the data element as they are no longer running sequentially. Sequence 13172 anticipated life expectancy of less than one year is a new data element for TAVR procedures. Coding for this data element is based on physician documentation. When there is no documentation to support coding and clarification with the physician is not available, sequence 13172 would be left blank and sequence 14454 anticipated life expectancy of less than one year not documented would be captured. This data element would not be coded by the abstractor as it is based on physician knowledge of comorbidities and other factors not related to the aortic disease. This data element was added to the full data set for use in future evaluation for appropriate use criteria or AUC. Sequence 13186 symptoms of aortic stenosis present is a new data element to TAVR and is coded on any symptoms of heart failure within the last three months prior to the start of the TAVR procedure. This data element may be coded by the abstractor based on physician documentation or on information in the medical record. If there is documentation of patient symptoms within the last three months, even if there are no symptoms of heart failure on arrival for the procedure, please code yes. When there is documentation of symptoms such as shortness of breath but no physician documentation of heart failure, please code yes. This data element was added to the full data set for use in the evaluation of AUC appropriate use criteria. Sequence 13496 syntax score is a new data element specific to TAVR procedures. The syntax score is a grading tool that is used to determine the complexity of coronary artery disease in the patient's native vessels. This tool is only used when left-main disease or three-vessel disease in the native vessels has been identified. When the syntax score has not been documented in the medical record prior to the procedure, please leave sequence 13496 blank and code sequence 13497 syntax score not documented. The coding of sequence 13468 aortic valve morphology for version 3.0 represents a change in target value and coding options. In version 2.1, the target value was any occurrence between 12 months prior to the procedure and start of the procedure. The selections of the valve morphology were based on the most recent morphology seen on imaging studies. For version 3, sequence 13468 will be coded to the value at birth and the morphology will have less selections and will focus on the earliest known valve type. If the patient was born with a normal trileaflet aortic valve and later diagnosed with fused leaflets, possibly due to calcifications or other medical conditions, please code tricuspid. Sequence 13469 ascending aorta size is a new data element for TAVR. This data element seeks to determine if the ascending aorta size has been documented in the medical record based on echocardiographic findings. When the size is not documented, please leave sequence 13469 blank and code sequence 13470 ascending aorta size not documented. Sequence 13700 low flow is a new data element to the TAVR module and is a child field of aortic stenosis. When aortic stenosis is coded as yes and the echo result for the AV mean gradient sequence 13674 is less than 40 millimeters of mercury, then low flow would be coded when the stroke volume index is less than 35 milliliters per square meter. If the AV mean gradient or low flow is not documented in the echo report, please leave sequence 13700 blank and code sequence 13701 low flow not documented. This data element was added to the full data set for use in evaluation for future appropriate use criteria, because in some cases it is not appropriate to perform a transcatheter aortic valve procedure in patients with low flow. For sequence 13319, indicate if a dibutamine challenge was performed. A dibutamine challenge is a type of stress echocardiography that can distinguish between true severe versus pseudo severe aortic stenosis and has a target value of any occurrence between 12 months prior to arrival and start of the first procedure. Sequence 13319 is a parent field for sequence 13320 flow reserve present and for sequence 13321 aortic stenosis type, which we will discuss in the next few slides. This data element was added to the full data set for use in evaluation for AUC to determine if it is appropriate to perform an aortic transcatheter procedure on a patient with pseudo severe aortic stenosis. When the dibutamine challenge is coded as yes, the next question will be is flow reserve present. Sequence 13320 would be coded as yes if there is an increase in the stroke volume index of greater than or equal to 20% as a result of the dibutamine challenge. This data element was added to the full data set for use in evaluation for AUC to determine the appropriateness of performing an aortic valve transcatheter procedure on a patient with flow reserve present. Sequence 13321 seeks to indicate the aortic stenosis type documented on the dibutamine challenge. Truly severe aortic stenosis is defined as an aortic valvaria less than or equal to 1 centimeter squared and Vmax peak aortic jet velocity greater than 4 meters per second at any flow rate. When aortic stenosis is not documented and clarification with the physician is unavailable, leave sequence 13321 blank and code sequence 13325 aortic stenosis type not documented.

TAVR procedures

data elements

anticipated life expectancy

symptoms of aortic stenosis

syntax score