DOCSLIB.ORG

Impact of Percutaneous Mitral Valve Repair Using the Mitraclip System on Tricuspid Regurgitation

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Impact of Percutaneous Mitral Valve Repair Using the Mitraclip System on Tricuspid Regurgitation CLINICAL RESEARCH INTERVENTIONS FOR VALVULAR DISEASE AND HEART FAILURE Euro Intervention 2016;11: e 1680- e 1686 published online online published Impact of percutaneous mitral valve repair using the MitraClip system on tricuspid regurgitation e Antonio H. Frangieh1, MD, MPH; Christiane Gruner2, MD; Fran Mikulicic2, MD; -edition April 2016 Adrian Attinger-Toller1, MD; Felix C. Tanner2, MD; Maurizio Taramasso3, MD; Roberto Corti1,4, MD; Jürg Grünenfelder3,4, MD; Thomas F. Lüscher1, MD; Frank Ruschitzka5, MD; Dominique Bettex6, MD; Francesco Maisano3, MD; Oliver Gaemperli1*, MD 1. Andreas Grüntzig Cardiac Catheterization Laboratories, University Heart Center, Zurich, Switzerland; 2. Echocardiography, University Heart Center, Zurich, Switzerland; 3. Cardiac Surgery, University Heart Center, Zurich, Switzerland; 4. Heart Clinic Hirslanden, Zurich, Switzerland; 5. Heart Failure Clinic, University Heart Center, Zurich, Switzerland; 6. Cardiac Anesthesiology, University Hospital Zurich, Zurich, Switzerland KEYWORDS Abstract Aims: Tricuspid regurgitation (TR) severity and right ventricular (RV) dysfunction have been identified as • MitraClip significant predictors of outcome after mitral valve surgery. The aim of the present study was to investigate • mitral regurgitation the impact of percutaneous mitral valve repair (PMVR) with the MitraClip system on functional TR sever- • percutaneous ity and RV function. mitral valve repair Methods and results: • right ventricle Among 119 consecutive patients with severe mitral regurgitation who under- • tricuspid went PMVR, 67 had complete baseline and follow-up transthoracic echocardiography after 3-12 months regurgitation (6.8±2.9 months). TR severity was graded as mild, moderate, and severe. RV systolic function was assessed by fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE). Clinical end- points at follow-up included mortality, reoperation of the mitral valve, hospitalisation for congestive heart failure and New York Heart Association (NYHA) functional class. After PMVR, a significant decrease in TR severity (by at least one grade) was observed in 22 (33%) patients, while an increase occurred in only seven (10%) patients (p=0.02). Overall, systolic RV function (FAC and TAPSE), RV dimensions, and tri- cuspid annular diameter did not change significantly. Baseline SPAP was significantly higher (57±15 vs. 43±14 mmHg, p=0.002) and SPAP reduction significantly larger (-14±13 versus 1±15 mmHg, p=0.012) in patients who improved their TR. Multivariate logistic regression analysis identified the change in SPAP as the only significant predictor of changes in TR (odds ratio [OR] [for every change in SPAP by 10 mmHg] DOI: 1.90, 95% CI: 1.02±3.54; p=0.044). Patients with mild/moderate TR at follow-up after PMVR had lower 10.4244/EIJV11I14A320 event rates compared to those with severe TR (35% vs. 78%, respectively, p=0.025). Conclusions: PMVR using the MitraClip device improves functional TR severity in approximately one third of patients, particularly in those who experience a significant SPAP reduction after the procedure. *Corresponding author: Andreas Gruntzig Laboratories and Cardiac Imaging, University Heart Center, Rämistrasse 100, 8091 Zurich, Switzerland. E-mail: [email protected] © Europa Digital & Publishing 2016. All rights reserved. SUBMITTED ON 02/03/2015 - REVISION RECEIVED ON 1st 24/04/2015 / 2 nd 16/05/2015 - ACCEPTED ON 29/05/2015 e1680 MitraClip and tricuspid regurgitation Euro Intervention Introduction PERCUTANEOUS MITRAL VALVE REPAIR (PMVR) Severe mitral regurgitation (MR) is associated with progressive left PROCEDURE ventricular dysfunction and congestive heart failure, leading to high PMVR with the MitraClip device was performed according rates of morbidity and mortality1. In Europe, MR is the second most to standard technique described elsewhere16 with echocardio- 2016;11: frequent valve disease requiring surgery2. Recently, percutaneous graphic (three-dimensional transoesophageal echocardiography) mitral valve repair (PMVR) with the MitraClip® system (Abbott and fluoroscopic guidance, and under general anaesthesia. Acute e Vascular, Santa Clara, CA, USA) has emerged as a safe, less inva- procedural success (APS) was defined as successful MitraClip 1680- sive, alternative therapeutic option to surgery, in patients with implantation with immediate MR reduction to grade 2+ or less by e moderate to severe MR and high surgical risk. Based on the favour- echocardiography. 1686 able results of several multicentric investigator-driven registries3-6 and the results of one randomised trial7, the technique has gained ECHOCARDIOGRAPHY wide acceptance with more than 16,000 patients treated so far. On Transthoracic echocardiography was performed at baseline (shortly 24 October 2013 the MitraClip received FDA approval for use in prior to the PMVR procedure) and at follow-up three to 12 months patients with degenerative MR and at prohibitive surgical risk8. after PMVR. All echocardiographic films were stored in our clini- Functional tricuspid regurgitation (TR), which occurs on struc- cal image database and independently reviewed by an experienced turally normal tricuspid valves, is frequently observed in patients reader, blinded to the clinical history of the patient. A second with MR9. Paradoxically, TR tends to worsen after mitral valve reader re-evaluated TR severity (baseline and follow-up) to assess surgery10 (particularly in patients with ischaemic or dilative car- inter-observer variability. TR quantification, as well as evaluation diomyopathy), with close to 50% of patients having postoperative of RV dimensions and function, were performed according to the TR despite successful surgery with lowering of pulmonary pres- recommendations of the American Society of Echocardiography sure9. The severity of TR may increase even further in the years (ASE), the European Association of Echocardiography and the following surgery, and is associated with worse outcomes11. Some Canadian Society of Echocardiography15,17. have proposed impaired right ventricular function6 and/or geo- In brief, TR severity was graded as mild, moderate or severe metrical distortion of the tricuspid annulus after MV surgery as based on integration of various Doppler parameters (central the underlying mechanism for postoperative TR9,12. PMVR with jet area, density and contour, vena contracta width and hepatic the MitraClip has only a slight impact on mitral annular geom- vein flow) and the dimensions of the right-sided chambers. End- etry and has been shown to induce reverse left ventricular (LV) systolic and end-diastolic RV dimensions were measured by remodelling13, but its effect on RV dimensions and function, tri- planimetry from the RV-focused apical 4-chamber (4CH) view17. cuspid annular geometry and TR has not been extensively inves- RV function was assessed through fractional area change (FAC) tigated as yet14. defined as ([4CH end-diastolic area–4CH end-systolic area]/4CH The purpose of this study was therefore to explore changes end-diastolic area×100) as well as the tricuspid annular plane sys- in TR severity and RV function after PMVR, and to relate these tolic excursion (TAPSE) acquired on M-mode tracings through findings to acute and long-term procedural success and patient the tricuspid annulus17. MR severity was graded from 1+ to 4+ outcome. according to ASE recommendations15. Systolic pulmonary artery pressure (SPAP) was calculated from peak tricuspid regurgitant jet Methods velocity using the simplified Bernoulli’s equation and adding an PATIENT POPULATION AND STUDY DESIGN estimate of right atrial pressure estimated from the inferior vena We included consecutive patients who underwent PMVR using the cava diameter17. MitraClip system at the University Hospital Zurich and had base- line and follow-up transthoracic echocardiography (TTE) availa- CLINICAL FOLLOW-UP ble. Exclusion criteria included a recent myocardial infarction or Clinical outcome was obtained from hospital records or by direct revascularisation, any cardiac surgery, repeat PMVR, or cardiac interrogation of the patient or his/her general practitioner. Clinical resynchronisation therapy (CRT) device implantation <6 weeks endpoints included death, recurrent hospitalisation for congestive prior to the index PMVR or during follow-up, or degenerative TR heart failure (CHF), mitral valve surgery, and New York Heart aetiology. Indications for PMVR included symptomatic moderate Association (NYHA) functional class. CHF was defined by the to severe (3+) or severe (4+) MR15, with a high risk for surgery. classic Framingham criteria, with two major or one major and two An interdisciplinary Heart Team, which included an interventional minor criteria required to diagnose CHF18. cardiologist, a cardiac surgeon, an echocardiographer, and a car- diac anaesthetist, discussed each subject’s eligibility for PMVR. STATISTICAL ANALYSIS All patients gave written informed consent to be included in a pro- Statistical analysis was performed with SPSS, Version 20 (IBM spective MitraClip registry (KEK-ZH-Nr. 2010-0466). The proto- Corp., Armonk, NY, USA). Quantitative data are expressed col of the registry was approved by the cantonal ethical committee as mean±SD or median with interquartile range (IQR) where of Zurich. appropriate and were compared using the Student’s t-test or the e1681 Euro Intervention Mann-Whitney U test, respectively. Categorical data are given in Table 1. Baseline characteristics. Comparison between
Load more

Recommended publications
  • Closed Mitral Commissurotomy—A Cheap, Reproducible and Successful Way to Treat Mitral Stenosis
    149 Editorial Closed mitral commissurotomy—a cheap, reproducible and successful way to treat mitral stenosis Manuel J. Antunes Clinic of Cardiothoracic Surgery, Faculty of Medicine, University of Coimbra, Coimbra, Portugal Correspondence to: Prof. Manuel J. Antunes. Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal. Email: [email protected]. Provenance and Peer Review: This article was commissioned by the Editorial Office, Journal of Thoracic Disease. The article did not undergo external peer review. Comment on: Xu A, Jin J, Li X, et al. Mitral valve restenosis after closed mitral commissurotomy: case discussion. J Thorac Dis 2019;11:3659-71. Submitted Oct 23, 2019. Accepted for publication Nov 29, 2019. doi: 10.21037/jtd.2019.12.118 View this article at: http://dx.doi.org/10.21037/jtd.2019.12.118 In the August issue of the Journal, Xu et al. (1), from Bayley (4,5) and then became widely accepted. Subsequently, China, discuss the case of a patient who had a successful the technique of CMC suffered several modifications, both reoperation for restenosis of the mitral valve performed in the way the mitral valve was accessed and split. Several 30 years after closed mitral commissurotomy (CMC). instruments were created to facilitate the opening of the The specific aspects of this case were most appropriately commissures, culminating with the development of the commented by several experienced surgeons from different Tubbs dilator, which became the standard instrument for parts of the world. I was now invited by the Editor of this the procedure (Figure 1). Journal to write a Comment on this paper and its subject.
    [Show full text]
  • View Pdf Copy of Original Document
    Phenotype definition for the Vanderbilt Genome-Electronic Records project Identifying genetics determinants of normal QRS duration (QRSd) Patient population: • Patients with DNA whose first electrocardiogram (ECG) is designated as “normal” and lacking an exclusion criteria. • For this study, case and control are drawn from the same population and analyzed via continuous trait analysis. The only difference will be the QRSd. Hypothetical timeline for a single patient: Notes: • The study ECG is the first normal ECG. • The “Mildly abnormal” ECG cannot be abnormal by presence of heart disease. It can have abnormal rate, be recorded in the presence of Na-channel blocking meds, etc. For instance, a HR >100 is OK but not a bundle branch block. • Y duration = from first entry in the electronic medical record (EMR) until one month following normal ECG • Z duration = most recent clinic visit or problem list (if present) to one week following the normal ECG. Labs values, though, must be +/- 48h from the ECG time Criteria to be included in the analysis: Criteria Source/Method “Normal” ECG must be: • QRSd between 65-120ms ECG calculations • ECG designed as “NORMAL” ECG classification • Heart Rate between 50-100 ECG calculations • ECG Impression must not contain Natural Language Processing (NLP) on evidence of heart disease concepts (see ECG impression. Will exclude all but list below) negated terms (e.g., exclude those with possible, probable, or asserted bundle branch blocks). Should also exclude normalization negations like “LBBB no longer present.”
    [Show full text]
  • Medicare National Coverage Determinations Manual, Part 1
    Medicare National Coverage Determinations Manual Chapter 1, Part 1 (Sections 10 – 80.12) Coverage Determinations Table of Contents (Rev. 10838, 06-08-21) Transmittals for Chapter 1, Part 1 Foreword - Purpose for National Coverage Determinations (NCD) Manual 10 - Anesthesia and Pain Management 10.1 - Use of Visual Tests Prior to and General Anesthesia During Cataract Surgery 10.2 - Transcutaneous Electrical Nerve Stimulation (TENS) for Acute Post- Operative Pain 10.3 - Inpatient Hospital Pain Rehabilitation Programs 10.4 - Outpatient Hospital Pain Rehabilitation Programs 10.5 - Autogenous Epidural Blood Graft 10.6 - Anesthesia in Cardiac Pacemaker Surgery 20 - Cardiovascular System 20.1 - Vertebral Artery Surgery 20.2 - Extracranial - Intracranial (EC-IC) Arterial Bypass Surgery 20.3 - Thoracic Duct Drainage (TDD) in Renal Transplants 20.4 – Implantable Cardioverter Defibrillators (ICDs) 20.5 - Extracorporeal Immunoadsorption (ECI) Using Protein A Columns 20.6 - Transmyocardial Revascularization (TMR) 20.7 - Percutaneous Transluminal Angioplasty (PTA) (Various Effective Dates Below) 20.8 - Cardiac Pacemakers (Various Effective Dates Below) 20.8.1 - Cardiac Pacemaker Evaluation Services 20.8.1.1 - Transtelephonic Monitoring of Cardiac Pacemakers 20.8.2 - Self-Contained Pacemaker Monitors 20.8.3 – Single Chamber and Dual Chamber Permanent Cardiac Pacemakers 20.8.4 Leadless Pacemakers 20.9 - Artificial Hearts And Related Devices – (Various Effective Dates Below) 20.9.1 - Ventricular Assist Devices (Various Effective Dates Below) 20.10 - Cardiac
    [Show full text]
  • Comparison of Isothermic and Cold Cardioplegia in Cardiac Surgery in Salem District
    Pon. A. Rajarajan. Comparison of isothermic and cold cardioplegia in cardiac surgery in Salem District. IAIM, 2019; 6(3): 266-271. Original Research Article Comparison of isothermic and cold cardioplegia in cardiac surgery in Salem District Pon. A. Rajarajan* Associate Professor. Department of Cardio-Thoracic Surgery, Government Mohan Kumaramangalam Medical College Hospital, Salem, Tamil Nadu, India *Corresponding author email: [email protected] International Archives of Integrated Medicine, Vol. 6, Issue 3, March, 2019. Copy right © 2019, IAIM, All Rights Reserved. Available online at http://iaimjournal.com/ ISSN: 2394-0026 (P) ISSN: 2394-0034 (O) Received on: 03-03-2019 Accepted on: 09-03-2019 Source of support: Nil Conflict of interest: None declared. How to cite this article: Pon. A. Rajarajan. Comparison of isothermic and cold cardioplegia in cardiac surgery in Salem District. IAIM, 2019; 6(3): 266-271. Abstract Background: Perioperative myocardial damage is one of the most common causes of morbidity and mortality after heart surgery. The improvement of the technique of myocardial preservation has contributed greatly to significant advances in cardiac surgery. However, serious questions remain regarding the use of warm versus cold cardioplegia, blood versus crystalloid cardioplegia, antegrade versus retrograde delivery and intermittent versus continuous perfusion. Cardioplegic solution is the means by which the ischemic myocardium is protected from cell death. This is achieved by reducing myocardial metabolism through a reduction in cardiac workload and by the use of hypothermia. Chemically, the high potassium concentration present in most cardioplegic solutions decreases the membrane resting potential of cardiac cells. The normal resting potential of ventricular myocytes is about -90 mV.
    [Show full text]
  • Icd-9-Cm (2010)
    ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular
    [Show full text]
  • Cardiac Surgery
    Minimally Invasive Port-Access Cardiac Surgery Lawrence M Prescott, phlp OVLRVlEW OF CARDIAC SURGERY tions, pain and suffering, convalescence and cost, while main- Since heart surgery was pioneered in the mid-1950s. remark- taining the high efficacy of conventional open-chest surgery. able advances have occurred in the surgical treatment of car- One of these approaches, percutaneous transluminal coro- diovascular disease. Coronary artery bypass graft (CAW) pro- nary angioplasty (PTCA) or balloon angioplasty was devel- cedures are the most effective treatment for coronary artery oped as an altemative to coronary artery bypass graft (CABG) disease. This treatment utilizes an artery or vein to bypass the surgery. While less invasive than conventional CAW, a narrowing in a coronary artery and restore blood flow down- major drawback of PTCA is the high frequency of restenosis, stream of the narrowing. For valvular heart disease (VHD), which occurs at rates ranging from 25 percent to 50 percent. the treatment involves either repairing the diseased heart Ultimately, the majority of angioplasty patients undergo valve, most commonly with the implantation of a prosthetic another PTCA procedure or CABG surgery. annul~plastyring, or replacing it with a prosthetic mechanical Another less-invasive altemative to cokentional open-chest or tissue valve. CABG surgery was developed by a $mall number of cardiac sur- All the surgical procedures in conventional heart surgery geons. For this procedure, surgeons have been using off-the-shelf require a highly invasive technique, a stemotomy, that tools to perform minimally invasive CABG surgery on the beat- involves opening the patient's chest to gain access to the ing heart.
    [Show full text]
  • Structured Review of Post-Cardiotomy Extracorporeal Membrane Oxygenation
    ACCEPTED MANUSCRIPT Structured review of post-cardiotomy extracorporeal membrane oxygenation: part 2 - Pediatric patients Roberto Lorussoa*, MD, PhD, Giuseppe Maria Raffab*, MD, Mariusz Kowalewskic , MD, Khalid Alenizya, MD, Niels Sluijpersa, MD, Maged Makhoula, MD, Daniel Brodied, MD, Mike McMullane, MD, I-Wen Wangf, MD, Paolo Meanig, MD, Graeme MacLarenh, MD, Heidi Daltoni, MD, Ryan Barbaroj, MD, Xaotong Houk, MD, Nicholas Cavarocchil, MD, Yih-Sharng Chenm, MD, PhD, Ravi Thiagarajann, MD, PhD, Peta Alexandern, MBBS, Bahaaldin Alsoufio, MD, PhD, Christian A. Bermudezp, MD, Ashish S. Shahq, MD, Jonathan Haftr, MD, Lilia Oretos, MD, David A. D’Alessandrot, MD, Udo Boekenu, MD, PhD, and Glenn Whitmanv, MD From the aCardio-Thoracic Surgery Dept., Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands; bDepartment for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS—ISMETT (Istituto Mediterraneo per I Trapianti e Terapie ad alta specializzazione), Palermo, Italy; cDepartment of Cardiac Surgery, Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland; dDivision of Pulmonary & Critical Care Medicine, Columbia University, New York, NY; eCardiac Surgery Unit, Seattle Children Hospital, Seattle, Washington; fCardiac Transplantation and Mechanical Circulatory Support Unit, Indiana University School of Medicine, Health Methodist Hospital, Indianapolis, Indiana; gCardiology Dept., Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands;
    [Show full text]
  • Design and Development of a Combined Cardiovascular Assist System for Support in Severe Ventricular Failure
    RICE UNIVERSITY DESIGN AND DEVELOPMENT OF A COMBINED CARDIOVASCULAR ASSIST SYSTEM FOR SUPPORT IN SEVERE VENTRICULAR FAILURE by Robert L. Peterson A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE THESIS DIRECTOR'S SIGNATURE: (MAY 1979) ABSTRACT Title: Design and Development of a Combined Cardiovascular Assist System for Support in Severe Ventricular Failure Author: Robert L. Peterson This thesis work documents the design and testing of a ventricular assist system combining intra-aortic balloon pumping (IABP) with partial veno-arterial bypass (VABP), both pulsatile and nonpulsatile. A series of animal experiments was carried out after verification of the concept on a mock circulation. Although statistical significance was not obtained, the results were encouraging. This system combines the beneficial features of the two devices in a synergistic manner to obtain a system capable of total body support while at the same time improving the viability of the damaged myocardium. IABP, itself incapable of supporting the circulation in severe heart failure, is used to reduce the afterload caused by VABP, which can provide more profound circulatory assistance. Diastolic augmentation by pulsatile VABP enhances that due to IABP, and there is further enhancement of IABP function due to increased mean arterial pressure. A decrease in heart preload pressure was seen which reflected the decreased venous return brought about by bypass. Thus, in spite of increased total body perfusion, cardiac output was diminished. The decrease in cardiac output was sufficient to reduce heart flow work even though there was an increase in afterload pressure. Finally, the state of the animal seemed to be improved by the assist system in that arrhythmia and mortality were decreased during combined assistance.
    [Show full text]
  • Postoperative Care of the Open-Cardiotomy Patient
    POSTOPERATIVE CARE OF THE OPEN-CARDIOTOMY PATIENT HAROLD F. KNIGHT, JR., M.D.,* and DONALD B. EFFLER, M.D. Department of Thoracic Surgery PEN-CARDIOTOMY patients require a postoperative program that is O individualized and meticulously supervised. There are no rules that can serve as a fixed guide for proper care. Experience in 103 operations, in 86 of which we performed elective cardiac arrest with potassium citrate,1-2 has established for us a set of procedures useful in the postoperative care. It is the intent of this paper to elaborate upon these basic observations. It is not necessary to review the general care of patients recovering from thoracic surgical pro- cedures; our interest is confined at present to patients who have undergone open cardiotomy. The details of this postoperative program are of particular import in the care of children; adults do not require such precise attention, as their larger body mass makes small variations relatively less important. Immediately Postoperative Care The changes in patients during the hours immediately after open cardiotomy are sufficiently rapid and severe that it is mandatory to have a qualified team in constant attendance. This is best accomplished with a special-care unit designed and equipped exclusively for these patients. The basic team should include a resident physician well trained in thoracic surgery, and experienced nurses who are particularly interested in the field of cardiac surgery. A fortunate selection of capable personnel may be rewarded by a self-perpetuating system as the service demands grow. A detailed description of the equipment will not be given here; suffice it to say that the usual implements of the recovery room are basic and must be augmented by such specialized equipment as Croupettes, inter- mittent positive-pressure-demand valves (such as the Bennett device), a large- screen monitor for the electrocardiogram, and specialized emergency pharma- ceuticals.
    [Show full text]
  • Instructions and Data Element Definitions Form DOH-2254A
    NEW YORK STATE DEPARTMENT OF HEALTH DIVISION OF QUALITY AND PATIENT SAFETY CARDIAC SERVICES PROGRAM 2014 Discharges Cardiac Surgery Report, Adult (Age 18 and Over) Instructions and Data Element Definitions Form DOH-2254a CARDIAC SERVICES PROGRAM CONTACTS: One University Place, Suite 218 Rensselaer, NY 12144-3455 Phone: (518) 402-1016 Fax: (518) 402-6992 Kimberly S. Cozzens, MA, Cardiac Initiatives Research Manager, [email protected] Rosemary Lombardo, MS, CSRS Coordinator, [email protected] Table of Contents Topic Page Revision Highlights and Coding Clarifications…………………..…………… 6 When to Complete an Adult CSRS Form ……………………………………. 6 Guidance on Selecting Appropriate Procedure Codes ………………….... 8 CSRS Data Reporting Policies ……………………………………….………. 10 ITEM-BY-ITEM INSTRUCTIONS PFI Number ………………………………………………………………... 12 Sequence Number ………………………………………………………... 12 I. Patient Information Patient Name ……………………………………………………………… 12 Medical Record Number …………………………………………………. 12 Social Security Number ………………………………………………….. 12 Date of Birth ………………………….………………………….………… 12 Sex ………………………….………………………….…………………… 13 Ethnicity ………………………….………………………….……………... 13 Race ………………………….…………………………………………….. 13 Residence Code ………………………….……………………………….. 14 Hospital Admission Date ………………………….……………………… 14 Primary Payer ………………………….………………………………….. 14 Medicaid ………………………….………………………….…………….. 15 PFI of Transferring Hospital ………………………….………………….. 15 II. Procedural Information Hospital That Performed Diagnostic Cath ………………………….…… 16 Date of Surgery ………………………….…………………………………
    [Show full text]
  • Heparin Coating and Cardiotomy Suction in Cardiopulmonary Bypass
    Heparin Coating and Cardiotomy Suction in Cardiopulmonary Bypass Staffan Svenmarker Department of Surgical and Perioperative Science Umeå University, Umeå, Sweden 2003 Umeå University Medical Dissertations New Series No. 855 - ISSN 0346-6612 – ISBN 91-7305-523-9 From the Department of Surgical and Perioperative Science Umeå University, Umeå, Sweden Heparin Coating and Cardiotomy Suction in Cardiopulmonary Bypass Staffan Svenmarker Fakultetsopponent: Professor Jarle Vaage Department of Surgery, Ullevål University Hospital University of Oslo, Norway Umeå 2003 Copyright 2003 Staffan Svenmarker ISBN 91-7305-523-9 Printed by Print & Media Umeå University, Sweden Hur förena tro med vetande? Frågan lär ju vara viktig. Kräva starkt arbetande, mycket ivrigt letande. Dumbom, något oförsiktig. Svarar: ”jo, när tron är riktig, är den vetande”. Gustav Fröding To my family: Barbro, Pontus, Anna and Magnus Table of Contents Abstract 7 Abbreviations 8 List of papers 9 Introduction Historical aspects of cardiopulmonary bypass 11 Introductory remarks to cardiopulmonary bypass 12 The systemic inflammatory response syndrome 14 Cardiopulmonary bypass and clinical outcome 17 The role of heparin coating 17 The role of cardiotomy suction 19 Cardiopulmonary bypass and the brain 20 Memory dysfunction 22 The protein S100 23 Aim of the investigations 27 Material & Methods Characteristics of population 28 General clinical management 30 Conduct of cardiopulmonary bypass 30 General assessments and measurements 31 Statistics 34 Results HCC and general clinical outcome
    [Show full text]
  • The 2012 Coding Manual Collection
    The 2012 Coding Manual Collection SaMple pageS ICD-9-CM Manual, Volumes 1, 2 & 3 (Hospital Edition) ICD-9-CM Manual, Volume 1 & 2 (Professional Edition) HCPCS Level II Manual The following 10 sample pages are from HCpro’s 2011 ICD-9-CM Coding Manual, Volumes 1, 2 & 3 SaMple pageS ICD-9-CM Manual, Volumes 1, 2 & 3 (Hospital Edition) 2011 ICD-9-CM Conventions HCPro’s ICD-9-CM manuals include all the symbols and conventions Please note: Certain categories of codes only consider a particular set of found in the government’s official version (see Preface and ICD-9-CM fifth digits to be a CC condition. Official Guidelines for Coding and Reporting). In addition, HCPro’s ICD- • For example: 9-CM manuals include the following icons and color-coded conventions: Category 403.9x. CC 1 ✓4 TH Fourth digit required. In order to accurately assign a diagnosis This means that ICD-9 code 403.90 is not considered a CC condition, but from this category, it requires the assignment of a fourth digit. 403.91 is designated as a CC condition. • For example: Category 465.x requires a fourth digit of a 0, 8, or 9 to be assigned an accurate code. MCC Major Complication and Comorbidity. This diagnosis is considered a major complication and/comorbidity. Assignment of these ✓5 TH Fifth digit required. In order to accurately assign a diagnosis from diagnoses as an additional code may impact DRG assignment. this category, it requires the assignment of a fifth digit. • For example: 585.6 (End stage renal disease) is • For example: Category 642.0x requires a fifth digit of a 0, 1, 2, 3, or designated as an MCC.
    [Show full text]