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  • 1. The French database for adult cardiac surgery : from project to program François Roques°, C De Riberolles°, M Dahan°, JL De Brux°, E Baudet°, R Wyse* FSCTCV Database Work Group ° EACTS Database Committee *The French Society of Thoracic and CardioVascular surgery , via its Database Working Group, is launching hisdatabase program for adult cardiac surgery. Details of this program are available in French in document 1. InSeptember 2001 a questionnaire was sent to society cardiac surgeons to collect opinions about the need for thisprogram and to obtain an instance picture of data collection in cardiac surgery in France . In all, almost every Frenchcardiac surgeon agreed to the development of a cardiac surgery database under the authority of FSCTCV; all wereready to participate, providing that confidentiality of records is guaranteed (document 2). The database was expected tobe compatible with international system by most. In half of the centers, the surgeons had already developed their owncomputerized evaluation system that they wished to retain. Others, working in poorly computerized units were ready touse a software proposed or approved by the FSCTCV. These results have led to first publish guidelines for datacollection in order to allow the improvement of existing systems as well as develop specific software. The objectives ofthe Database Working Group were to develop a database that is fully compatible to the STS and the British Database.This was based on the Richard Wyse’s study that aimed at sharing individual national experiences in order to developan international adult cardiac surgery database. Attention was paid in the development of the database to anyadditional items used to comply with the French administrative requirements (e.g., French DRG) or to allow riskstratification independently from the scoring system chosen (EuroSCORE, Parsonnet, Tu, Cleveland…..). It was alsodesigned to allow for semi-automatic operative and hospital records. The database consist of 442 fields. Among them,162 are STS items , 147 are STS compatible, and 61 arise from the British Database. Other items are country-specific(64), or mandatory for score calculations (5). Details are available in English on the data collection form in appendix.Definitions and formats are detailed in French in document 4c and 4d. The Database Working Group policy was to useSTS definition for all STS or STS-compatible fields .A pilot program on 10 centers that utilize the FSCTCV system will begin in July 2002.In addition, the FSTCVS has planed to develop an accreditation program based on the British society’s experience andthe work of the Audit and Guideline Committee of the EACTS. Expert on-site review is expected to begin in volunteercenters in June 2003.Compiled by Dr Richard Wyse. London, 2000 - 2001. With specific thanks for their help (among many others) to K. Taylor, F. Grover, B. Keogh,F. Roques, B. Bidstrup, B. Ferguson, S. Dziuban, F. Edwards A. Krian, P. Kalmar, S. Takamoto, M. Benedicta-Edwards, P. Sargeant.Modified in order to comply with french administrative requirements.
  • 2. International Adult Cardiac Surgery and French Society of Thoracic and CardioVascular Surgeon Data Collection Form (Richard Wyse and the SFCTCV database work group: François Roques, C De Riberolles, M Dahan, JL De Brux, E.Baudet)ADMINISTRATIVE Hospital ID: |___|___|___|___|___|___|___|___|DEMOGRAPHICS Patient Medical Record Number: _______________ Last Name: _________________________ First: __________________ Middle: ____ Date of Birth: __ __/__ __/__ __ __ __(mm/dd/yyyy) Place of birth: _________ Country of birth___________ Gender: Male Female Ethnic Origin: Caucasian Middle Eastern Indian Subcontinent Asian Black Hispanic Pacific Island/Maori Aboriginal/Torres Strait Latin American Other Unknown National ID Number: __________________ Postal Code: ______________ Referring Cardiologists Name: _______________________ Referring Physicians Name: _______________________ HOSPITALIZATION Hospital Name: ______________________________ Same Day Elective Admission: No Yes Date of - Admission: __ __/__ __/__ __ __ __ Surgery: __ __/__ __/__ __ __ __ Discharge: __ __/__ __/__ __ __ __PRE-OPERATIVE RISK FACTORS Weight: _____ (kg) Height: _____ (cm) BMI:……….. BSA: ………. (auto calculated) Atherosclerosis risk factors: Chronic Obesity (according to BMI) No Yes (Auto-calculated) Smoker: No Yes → Current Smoker: No Yes Family History of CAD: No Yes Diabetes: No Yes → Diabetes Control: None Diet Oral Therapy Insulin Hypercholesterolemia: No Yes Hypertension: No Yes Patient related Risk factors for cardiac surgery Renal Failure: No Yes if yes→ Acute Chronic If Yes→ Dialysis? No Yes Chronic Lung Disease: No Yes → Mild / Moderate / Severe COPD/Empysema No Yes Asthma No Yes Long term use of steroids No Yes Long term use of bronchodilators No Yes Infectious Endocarditis: No Yes → Infectious Endocarditis Type : Treated Active Immunosuppressive Treatment: No Yes Severe liver disease : No Yes Cerebrovascular Disease: No Yes → CVD type: Coma CVA RIND TIA Non Invasive >50 % carotid stenosisCompiled by Dr Richard Wyse. London, 2000 - 2001. With specific thanks for their help (among many others) to K. Taylor, F. Grover, B. Keogh,F. Roques, B. Bidstrup, B. Ferguson, S. Dziuban, F. Edwards A. Krian, P. Kalmar, S. Takamoto, M. Benedicta-Edwards, P. Sargeant.Modified in order to comply with french administrative requirements.
  • 3. If CVA: how many months ago: ……. if <1month, how many weeks ago: ……. If TIA: how many months ago : .……. if <1month, how many weeks ago: ……. If Carotid stenosis: __% Other Central Neurological Dysfunction No Yes Peripheral Neurologic Disease No Yes Peripheral Vascular Disease: No YesPREVIOUS INTERVENTIONS Previous Cardiovascular Intervention No Yes Date of Last Intervention __ __/__ __/__ __ __ __ a- Previous Cardiac Operation No Yes Date of Last Cardiac Operation __ __/__ __/__ __ __ __ number of Prior Cardiac Operations → Requiring Cardiopulmonary Bypass: ______ → Without Cardiopulmonary Bypass: ______ Previous Surgery - Coronary surgery/ valve surgery/ Ascending Aorta or Aortic Arch / Congenital Cardiac Other Cardiac/ Other Thoracic / Unknown b- Prior cardiological procedure: No Yes Interventional cardiology: No Yes: Balloon/ Atherectomy/ Stent: → if recent: how many hours ago: _ _ _ Thrombolysis: No Yes → if recent: how many hours ago: _ _ _ Balloon Valvuloplasty: No Yes c- Previous Vascular Operation No Yes → Descending or Abdominal Aorta Carotid endarterectomy Peripheral Vascular Vascular-related Amputation Other d- Recently failed intervention No Yes → Within 24 hours of surgery → > 24 hours surgery, same admissionPRE-OPERATIVE CARDIAC STATUS Symptom Status : Stable Unstable/Recent Deterioration Dypnea: NYHA : l ll lll lV Congestive Heart Failure: Never Now Past Unknown Angina: No Yes → Type: Stable Unstable↓ If unstable → Type: Rest Angina New Class 3 Recent Accel Variant Angina Non-Q MI Post- Infarct Angina Unknown CCS : 0 l ll lll lV Myocardial infarction: Number of MI: __ Unknown Last MI within 90 days: No Yes → If yes, when before surgery? : _ _ hours or _ _ _ days Critical state : Cardiogenic Shock: No Yes → Type: Refractory Shock Hemodynamic Instability Intravenous Inotropes No Yes IABP No Yes Ventilated No Yes Resuscitation: No Yes Arrhythmia (<2 wks Pre-op) : No Yes → Type: Sust VT/VF Heart Block AFib/Flutter Pacemaker No Yes → temporary permanentPRE-OPERATIVE MEDICATIONS Aspirin: No Yes Digitalis: No Yes Steroids: No Yes Other antiplatelets: No Yes Diuretics: No Yes ACE Inhibitors No YesCompiled by Dr Richard Wyse. London, 2000 - 2001. With specific thanks for their help (among many others) to K. Taylor, F. Grover, B. Keogh,F. Roques, B. Bidstrup, B. Ferguson, S. Dziuban, F. Edwards A. Krian, P. Kalmar, S. Takamoto, M. Benedicta-Edwards, P. Sargeant.Modified in order to comply with french administrative requirements.
  • 4. Beta Blockers: No Yes Nitrates – I.V.: No Yes Inotropic Agents: No Yes Anticoagulants: No Yes LAST PRE-OPERATIVE BLOOD EXAMS: Last Creatinine : ………μmol/l last sodium: ……………mmol/l last Prothrombin Time:………….%PRE OPERATIVE HAEMODYNAMICS and CATHETERIZATION DATA Catheterisation performed No Yes Catheterised during same admission? No Yes Date of most recent Cardiac Catheterisation __ __/__ __/__ __ __ __ Coronary arteries: No. of Diseased Coronary Vessels: None One Two Three Left Main Disease > 50%: No Yes (Note: LM Disease (>50%) counts for two: LAD+CFX) LV Function Good Medium Bad Ejection Fraction: → available: No/Yes If Yes _____ % → Method: None LV gram Echo Radionucleotide MRI estimated LVEDP : →available: No/Yes If Yes ______ mm Hg Right heart: Pulmonary Artery Systolic Pressure: : available: No/Yes If Yes ______ mm Hg Pulmonary Artery Mean Pressure: available: No/Yes If Yes ______ mm Hg PAWP available: No/Yes If Yes ______ mm Hg Valve: Aortic Stenosis: No Yes Gradient _ _ mm Hg Aortic Insufficiency: 0=None 1=Trivial 2=Mild 3= Moderate 4= Severe Mitral Stenosis: No Yes Gradient _ _ mm Hg Mitral Insufficiency: 0=None 1=Trivial 2=Mild 3= Moderate 4= Severe Tricuspid Stenosis: No Yes Gradient _ _ mm Hg Tricuspid Insufficiency: 0=None 1=Trivial 2=Mild 3= Moderate 4= Severe Pulmonic Stenosis: No Yes Gradient _ _ mm Hg Pulmonic Insufficiency: 0=None 1=Trivial 2=Mild 3= Moderate 4= SevereOPERATIVE Operating Surgeon _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Surgeon in charge _________________ st nd rd th th th th Operation Sequence 1 2 3 4 5 6 >6 Skin incision: Start time:………….. Stop time:…………….. a- Status of the procedure: Priority: * Elective * Urgent → Reason: AMI IABP Worsening CP CHF Anatomy USA Rest Angina Valve dysfunction Aortic aneurysm * Emergent →Reason: Shock Circ Support Shock No Circ Support Pulm Edema AEMI Ongoing Isch Valve dysf AA * Salvage Operation carried out before the next operating day? No Yes b- the procedure:Minimally Invasive Procedure Attempted? No Yes → (complete Minimally invasive section)Cardio-Pulmonary Bypass and/or Support used No Yes → (complete CPB and Support section)Coronary Artery Bypass: No Yes → (complete Coronary surgery section)Compiled by Dr Richard Wyse. London, 2000 - 2001. With specific thanks for their help (among many others) to K. Taylor, F. Grover, B. Keogh,F. Roques, B. Bidstrup, B. Ferguson, S. Dziuban, F. Edwards A. Krian, P. Kalmar, S. Takamoto, M. Benedicta-Edwards, P. Sargeant.Modified in order to comply with french administrative requirements.
  • 5. Valve surgery No Yes → (complete Valve surgery section)Other Cardiac Procedure? No Yes → (complete Other Cardiac Procedures section)Other Non-Cardiac Procedure? No Yes → (complete Other Non Cardiac Procedures section)MINIMALLY INVASIVE SURGERYa- Strategy: Pure Surgical Approach Combined Catheter Interventionb- Surgical approach 1. Primary Incision: (Sternotomy) Full Partial Transverse (Parasternal) Right Vertical Left Vertical (Thoracotomy) Right Anterior Left Anterior Posterolateral Xiphoid Epigastric Subcostal 2. Total # of Incisions: ______ 3. Conversion to Standard Incision: No Yes → Indication: Exposure Bleeding Rhythm Hypotension Conduitc- Robotic Techniques used No Yes → If yes, then tick all that apply:- CABG Aortic Mitral Tricuspid Pulmonaryd-minimally invasive coronary surgery: 1. Technique of IMA Harvest: None Direct Vision Thoracoscopy Combination 2. Vessel Stabilization Technique: None Suture Snare Suction Device Compression Other 3. Intracoronary Shunt used No Yes 4. Cumulative Ischemic Time (min) for LAD system: _____ RCA system: ______ CFX: ______ Intermediate _____ 5. Suture Technique: Running Interrupted Stapler Combination 6. Acute Flow Patency Assess of Grafts (Periop): None IntraOp Doppler IntraOp Angio Postop Angio Postop DopplerCARDIOPULMONARY BYPASS and SUPPORT OPCAB procedure attempted? No Yes CPB Used: No Yes → (already in Operative section)a-Cardiopulmonary bypass: 1. canulation Method: artery: site 1: site 2: site 3: site 4: select one of the following for each site: (0) no canulation, Asc Ao (1), Ao arch (2), fem (3), iliac (4), Axil R(5), Axil L(6), CarotR(7), Carot L(8), Ao Prost graft (9),other(99) vein: site 1: site 2: site 3: site 4: select one of the following for each site: (0) no canulation, R Atrial (1), vena cava S (2), vena cava I (3), fem V (4), iliac V (5), R jugular(6), L Sup vena cava (7), other (99) 2. Aortic Occlusion Method: None Cross-clamp Balloon Occlusion Cross Clamp Time (min): ___ Cumulative Bypass Time (min): ___ Lowest Temperature during CPB ___ Longest Ischaemic Period (min) if intermitent cross clamping _ _ _b- Myocardial protection, 1. Cardioplegia: No Yes if Yes *antegrade No Yes * Crystalloid Cardioplegia No Yes * retrograde No Yes * Blood Cardioplegia No Yes * Timing Intermittent Continuous * Blood Reperfusion No Yes * Temperature : Cold Tepid Warm 2. Non Cardioplegic Protection: XC Fibrillation,Coronary Perfusion, Beating Heart+Perfusion, VF + Perfusion, Beating Heart+XCc- CNS Protection : No Yes if Yes → Deep Hypothermic Circulatory Arrest : Circulatory Arrest Time ___ Deep Hypothermic Circulatory Arrest with Retrograde Cerebral Perfusion: Circulatory Arrest Time ___ Antegrade Cerebral Perfusion without circulatory arrest Antegrade Cerebral Perfusion time_ _ _Compiled by Dr Richard Wyse. London, 2000 - 2001. With specific thanks for their help (among many others) to K. Taylor, F. Grover, B. Keogh,F. Roques, B. Bidstrup, B. Ferguson, S. Dziuban, F. Edwards A. Krian, P. Kalmar, S. Takamoto, M. Benedicta-Edwards, P. Sargeant.Modified in order to comply with french administrative requirements.
  • 6. Otherd- Cardiac assistance No Yes 1- IABP No Yes → When serted: Preop Intraop Postop →Indication: Hemodynamic Instability PTCA Support Unstable Angina CPB Wean Prophylatic 2- other: VAD No Yes BIVAD No Yes Total Artificial Heart No Yes Myoplasty No Yes PCPS No YesCORONARY SURGERY CABG associated with another cardiac surgery procedure? No Yes a-Graft site: Unplanned CABG: No Yes 1 proximal RCA 2 mid RCA 3 distal RCA 4 RCA- PDA 5RCA LV-branch 6 left main CA 7 proximal LAD 8 mid LAD 9 distal LAD 10 Diago 1 11 Diago 2 12 proximal CX 13 distal CX 14 intermediate 15 OM1 16 OM2 17 CX-PDA b-Type of distal anastomosis (DA) : 1-Side to End 2- Side to Side 3- End to End c-Local procedure for distal DA : 1-Routine 2- Endarteriectomy 3-vein patch d-Conduit: 1 Pedicule LIMA 2 pedicule RIMA 3 Pedicule RGEA 4 free LIMA 5 Free RIMA 6 Free GEA 7 Radial artery 8 long SV (leg) 9 long SV (thigh) 10 short SV 11 cephalic Vein 12 other 99 unknown e-Site of bypass proximal anastomosis (PA) : 1-none 2-Ascending aorta 3-Bypass conduit 4- coronary artery 5-otherFor every bypass, select the appropriate code for each categary:Bypass 1 : Site DA: ____ ; type of DA___; local proc DA____; conduit:______ site for PA:_______ If site of PA is 3 : select the code of the donor bypass:___ If site of PA is 4: select the code of the donor coronary artery:…………;Bypass 2 : Site DA: ____ ; type of DA___; local proc DA____; conduit:______ site for PA:_______ If site of PA is 3 : select the code of the donor bypass:___ If site of PA is 4: select the code of the donor coronary artery:…………;Bypass 3 : Site DA: ____ ; type of DA___; local proc DA____; conduit:______ site for PA:_______ If site of PA is 3 : select the code of the donor bypass:___ If site of PA is 4: select the code of the donor coronary artery:…………;Bypass 4 : Site DA: ____ ; type of DA___; local proc DA____; conduit:______ site for PA:_______ If site of PA is 3 : select the code of the donor bypass:___ If site of PA is 4: select the code of the donor coronary artery:…………;Bypass 5 : Site DA: ____ ; type of DA___; local proc DA____; conduit:______ site for PA:_______ If site of PA is 3 : select the code of the donor bypass:___ If site of PA is 4: select the code of the donor coronary artery:…………;Bypass 6 : Site DA: ____ ; type of DA___; local proc DA____; conduit:______ site for PA:_______ If site of PA is 3 : select the code of the donor bypass:___ If site of PA is 4: select the code of the donor coronary artery:…………;Compiled by Dr Richard Wyse. London, 2000 - 2001. With specific thanks for their help (among many others) to K. Taylor, F. Grover, B. Keogh,F. Roques, B. Bidstrup, B. Ferguson, S. Dziuban, F. Edwards A. Krian, P. Kalmar, S. Takamoto, M. Benedicta-Edwards, P. Sargeant.Modified in order to comply with french administrative requirements.
  • 7. OTHER CARDIAC PROCEDURES Myocardial Resection No Yes Ventricular Septal Defect (Acquired) Repair No Yes Atrial Septal Defect Repair No Yes Maze No Yes Cardiac Rupture Repair No Yes Constrictive Pericardectomy No Yes Batista No Yes Congenital Defect Repair No Yes Cardiac Tumour No Yes Transmyocardial Laser Revascularisation No Yes Cardiac Trauma No Yes Cardiac Transplant No Yes Autom Impl Cardioverter Def No Yes Pacemaker No Yes Heart and Lung Transplant No Yes if yes: Endocardial/ Epicardial Pulmonary Embolectomy No Yes Permanent/ Temporary LV Aneurysm Repair No Yes Other No Yes Other left ventricular restoration No YesOTHER NON CARDIAC PROCEDURES 1-Aortic surgery anatomy: - Aneurysm No Yes Aneurysm Type : Dissection True Pseudoaneurysm - Dissection No Yes Onset of Dissection : Acute (<= 2 weeks) Chronic ( > 2 weeks) Dissection Type Stanford A No Yes Stanford B No Yes -coarctation other congenital pathology: Atheromatous Mycotic Marfan siphilis graft infected Operative Indication : Dissection Dilatation Rupture Malperfusion Embolism Other Operative technique : Aorta – Patch No Yes Aortic – Tube No Yes Aorta – Valve Conduit No Yes Stent graft No Yes if yes: operative No Yes percutaneus No Yes Range of Replacement : valsalva sinus Ascending Asc +Arch Arch Descending Thoracocabdominal Abdominal 2- Other Carotid Endarterectomy No Yes Lung Transplant No Yes Other Vascular No Yes Other Thoracic No YesCompiled by Dr Richard Wyse. London, 2000 - 2001. With specific thanks for their help (among many others) to K. Taylor, F. Grover, B. Keogh,F. Roques, B. Bidstrup, B. Ferguson, S. Dziuban, F. Edwards A. Krian, P. Kalmar, S. Takamoto, M. Benedicta-Edwards, P. Sargeant.Modified in order to comply with french administrative requirements.
  • 8. VALVE SURGERY Is the valve surgery associated to another cardiac surgery procedure? No Yesa-Aetiology 1. Rheumatic chronic 2. Rheumatic acute 3. Congenital 4. Ischaemic 5. Marfans 6. Myxomatous Degeneration 7. Failed Prior Repair 8. Prosthetic Valve failure 9. Paraprosthetic leak/dehiscence 10. Prosthetic Valve thrombosis 11. Active Infection 12. Previous Infection13. Calcific Degeneration 14. Annuloaortic Ectasia 15. Other Degenerative Disease 16. Dissection 17. Tumour 99. Otherb-Type of procedure: Aortic: Mitral: Tricuspid: Pulmonary: a1 No m1 No t1 No p1 No a2 Replacement m2 Annuloplasty only t2 Annuloplasty Only p2 Replacement a3 Repair/Reconstruction m3 Replacement t3 Replacement p3 Reconstruction a4 Root Reconstruction Valve Conduit m4 Reconstruction w/ Annuloplasty t4 Reconstruction w/ Annuloplasty a5 Reconstruction w/ Valve Sparing m5 Reconstruction w/out Annuloplasty t5 Reconstruction w/out Annuloplasty a6 Resuspension Aortic Valve m6 replacement w/ sub valv preservation t6 Valvectomy a7 Resection Sub-Aortic Stenosis a8 replacement w/ ann enlargment Aetiology Procedure Prosthesis (see codes) (see codes) Code Model No Serial No Size (mm) Aortic: - __ __ Implant None M B H A R BD Implant: ______ _______ _______ ___ Explant None M B H A R BD Explant: ______ _______ _______ ___ Mitral:- __ __ Implant None M B H A R BD Implant: ______ _______ _______ ___ Explant None M B H A R BD Explant ______ _______ _______ ___ Tricuspid:- __ __ Implant None M B H A R BD Implant: ______ _______ _______ ___ Explant None M B H A R BD Explant: ______ _______ _______ ___ Pulmonary:- __ __ Implant None M B H A R BD Implant: ______ _______ _______ ___ Explant None M B H A R BD Explant: ______ _______ _______ ___ M = Mechanical, B = Bioprosthesis, H = Homograft, A = Autograft, R = Ring BD = BandCompiled by Dr Richard Wyse. London, 2000 - 2001. With specific thanks for their help (among many others) to K. Taylor, F. Grover, B. Keogh,F. Roques, B. Bidstrup, B. Ferguson, S. Dziuban, F. Edwards A. Krian, P. Kalmar, S. Takamoto, M. Benedicta-Edwards, P. Sargeant.Modified in order to comply with french administrative requirements.
  • 9. VALVE KEY (use either UK or US CODES) UK CODE US CODE UK CODE US CODE Bioprosthetic Mechanical PRIMA 2 B1= Edwards Prima Plus Stentless Porcine Bioprosthesis ATS M1= ATS Mechanical Prosthesis PRIMA B2= Edwards Prima Stentless Porcine Bioprosthesis BS (BSC/C) M2= Björk-Shiley Convex-Concave Mechanical Prosthesis BIOCOR B3= St. Jude Medical Epic Porcine Bioprosthesis BSM M3= Björk-Shiley Monostrut Mechanical Prosthesis BCRSL B4= Biocor Stentless Porcine Bioprosthesis CAR M4= CarboMedics Mechanical Prosthesis CEP B6= Carpentier-Edwards Perimount Pericardial Bioprosthesis ET M5= Edwards Tekna Mechanical Prosthesis CE B7= Carpentier-Edwards Standard Porcine Bioprosthesis LLK M6= Lillehei-Kaster Mechanical Prosthesis CES B8= Carpentier-Edwards Supra-Annular Porcine Bioprosthesis MED M7= Medtronic-Hall Mechanical Prosthesis CRYO B9= Cryolife OBrien Stentless Porcine Bioprosthesis OMNIC M8= OmniCarbon Mechanical Prosthesis HA B10= Hancock Standard Porcine Bioprosthesis OMNIS M9= OmniScience Mechanical Prosthesis HA2 B11= Hancock II Porcine Bioprosthesis ONX-Y M10= On-X Mechanical Prosthesis HAMO B12= Hancock Modified Orifice Porcine Bioprosthesis MIRA M11= Sorin Bicarbon (Baxter Mira) Mechanical Prosthesis ISP B13= Ionescu-Shiley Pericardial Bioprosthesis SO2 M12= Sorin Monoleaflet Allcarbon Mechanical Prosthesis LABT B14= Labcor stented Porcine Bioprosthesis SJM M13= St. Jude Medical Bileaflet Mechanical Prosthesis LASL B15= Labcor stentless Porcine Bioprosthesis SE M14= Starr-Edwards Caged-Ball Prosthesis FREE B16= Medtronic Freestyle Stentless Porcine Bioprosthesis ULC M15= Ultracor Mechanical Prosthesis INT B17= Medtronic Intact Porcine Bioprosthesis SJM = St Jude Medical HP Mechanical Prosthesis MOSAIC B18= Medtronic Mosaic Porcine Bioprosthesis SJM = St Jude Medical Masters Mechanical Prosthesis MITROFLOW B19= Sulzer Carbomedics Pericardial Bioprosthesis SJM = St Jude Masters Regent Mechanical Prosthesis SLSOB B20= Sorin Pericarbon Stentless Pericardial Bioprosthesis CAR = CarboMedics Top-Hat Mechanical Prosthesis TSPV B21= St. Jude Medical - Toronto SPV Stentless Porcine Bioprosthesis MED-A = Medtronic Advantage Mechanical Prosthesis SJB B22= St. Jude Medical-Bioimplant Porcine Bioprosthesis ATSL = ATS advanced performance Lecamed Mechanical Prosthesis BFO = Bioflo Bio Medical Pericardial BioProsthesis ANG = Aortech Angiocor Mechanical Prosthesis CONFORMA = Heartline Porcine Stentless Bioprosthesis AOT = Aortech Mechanical Prosthesis HAP = Hancock Bovine Pericardial Bioprosthesis BIC = Bicer Mechanical Prosthesis KLK = Killingbeck Porcine Bioprosthesis DM = Duromedics Mechanical Prosthesis LABCOR = Sulzer Model TLPB Porcine Pericardial Bioprosthesis JYROS = Axion Mechanical Prosthesis LI = Liotta St. Jude Medical Stented Porcine Bioprosthesis SCB = Cutter Caged-Ball Mechanical Prosthesis MSPC = Sulzer Mitroflow Synergy Bovine Pericardial Bioprosthesis SOM = Sorin Monoleaflet Mechanical Prosthesis PHOTOFIX = Sulzer Bovine Stented Pericardial Bioprosthesis BICARBON = Sorin Bileaflet Mechanical Prosthesis ROSS = Cryolife Porcine Stentless Bioprosthesis SHELL = CLS Porcine Stented Bioprosthesis SHLSL = CLS Porcine Stentless Bioprosthesis Homograft SOB = Sorin Pericarbon Stented Pericardial Bioprosthesis TAS = Medtronic Tascon Porcine Stented Bioprosthesis HOA H1= Homograft Aortic – Subcoronary TM = Aortech Porcine Stentless Bioprosthesis HOAR H2= Homograft Aortic Root/Cylinder TMVG = Aortech Combined Root Porcine Stentless Bioprosthesis HOM H3= Homograft Mitral TT = Aortech Porcine Stented Bioprosthesis HOP H4= Homograft Pulmonic Root WX = Sorin Wessex Porcine Stented Bioprosthesis CRYH H5= Cryolife Homograft XAG = Xenomedica Porcine Stented Bioprosthesis AUTOGEN = Autogen Autogenics Pericardial Autologous Prosthesis XAGPV = Xenomedica Porcine Valve Conduit Bioprosthesis DURA = Dura Mater Human Prosthesis X-CELL = St. Jude Medical Porcine Stented Bioprosthesis FASCIA = Fascia Lata Human Prosthesis XENOTECH = Xenolife Porcine Stented Bioprosthesis XENOFIC = Xenolife Bovine Stented Bioprosthesis ELAN = Aortech Porcine Stentless Bioprosthesis Autograft ASP = Aortech Aspire Porcine Stented Bioprosthesis AUTO A1= Autograft Pulmonic Root Ring CER R1= Carpentier-Edwards Classic Ring Conduit with Biological/Mechanical Valve CEPHYSIO R2= Carpentier-Edwards Physio Ring COS R3= Cosgrove-Edwards CEVC = Carpentier-Edwards valved conduit SCULPTOR R4= Medtronic Sculptor Ring HAVC = Hancock conduit DURAN R5= Medtronic-Duran Ring SJMVG = CAVG St Jude Medical PUIG R6= Sorin-Puig-Messana Ring CARVG = Carboseal Sulzer Carbomedics SEQUIN R7= St. Jude Medical Sequin Ring MEDVG = Aortic Conduit Medtronics TAILOR = St. Jude Tailor Ring CONTEGRA = Venpro Pericardial valved conduit = Sulzer Carbomedics Annuloflex ATS = ATS 502AG valved conduit = Sulzer Carbomedics Annuloflo 777= OtherCompiled by Dr Richard Wyse. London, 2000 - 2001. With specific thanks for their help (among many others) to K. Taylor, F. Grover, B. Keogh,F. Roques, B. Bidstrup, B. Ferguson, S. Dziuban, F. Edwards A. Krian, P. Kalmar, S. Takamoto, M. Benedicta-Edwards, P. Sargeant.Modified in order to comply with french administrative requirements.
  • 10. POST OPERATIVE POST-OPERATIVE INFORMATION Date and Time : ICU Arrival ICU Readmission (if required) ICU Discharge ICU Secondary Discharge (if readmitted) Extubation (primary) Re-intubation (if required) Extubation (secondary) Auto-calculated: ICU Stay (initial) _ _ _ _ ICU Stay (secondary) _ _ _ ICU Stay (overall)_ _ _ _ Hrs Ventilated (initial) _ _ _ after re-intubation _ _ _ total _ _ _ Highest Post-op Creatinine : ___ Blood Products Used: No Yes Autologous No Yes When Used : Preoperative Intraoperative Postoperative COMPLICATIONS (in hospital) Complications: No Yes Operative ReOperation for Bleeding No Yes Infection Sternum - Deep No Yes ReOperation for Valvular Dysfunction No Yes Sternum-superficialNo Yes ReOperation for Graft Occlusion No Yes LegNo Yes ReOperation for Other Cardiac Problem No Yes SepticemiaNo Yes ReOperation for Other Non Cardiac Problem No Yes ThoracotomyNo Yes ReOperation for deep sternal infection No Yes Urinary Tract No Yes ReOperation for re-suture of sternum No Yes Pulmonary Prolonged VentilationNo Yes Cardiac low cardiac output No Yes reintubationNo Yes Requiring inotropes No Yes Pneumonia No Yes Requiring IABP No Yes Pulmonary Embolism No Yes Requiring VADS No Yes Neurologic Stroke No Yes Arrhythmia No Yes Transient No Yes Atrial fibrillation No Yes Continuous Coma >=24Hrs No Yes Other SVT No Yes Paraplegia / Paraparesis No Yes TV/FV No Yes Confusion / psychosis No Yes Heart block No Yes Renal Renal Failure No Yes Requiring permanent pacing No Yes Dialysis Required No Yes Cardiac arrest No Yes Vascular Aortic Dissection No Yes Tamponade No Yes Illiac/Femoral Dissection No Yes Peri-operative MI No Yes Acute Limb Ischemia No Yes Multi-System Failure No Yes Other Anticoagulant Complication No Yes GI Complications No Yes Sternal dehiscence (not inf) No Yes Hemorrhage No Yes Mesenteric infarction No Yes Cholescystis No Yes Ileus No Yes Compiled by Dr Richard Wyse. London, 2000 - 2001. With specific thanks for their help (among many others) to K. Taylor, F. Grover, B. Keogh, F. Roques, B. Bidstrup, B. Ferguson, S. Dziuban, F. Edwards A. Krian, P. Kalmar, S. Takamoto, M. Benedicta-Edwards, P. Sargeant. Modified in order to comply with french administrative requirements.
  • 11. DISCHARGE STATUS Discharge Status: Alive Dead Status at 30 days after surgery: Alive Dead If alive, sent to : Home Other Hospital Other specialty, same Hospital Convalescence HomeUnknown At time of discharge, Patient Activities are : Not compromised Moderately Compromised Severely Compromised If dead: Date of death __ __/__ __/__ __ __ __ (mm/dd/yyyy) Location of Death: OR Hospital Home Other Facility Primary Cause of Death : Cardiac Neurological Renal Vascular Carcinoma Infection Pulmonary Valvular Bleeding Other (Specify) _ _ _ _ _ _ _ _ _ _ _ _ Autopsy performed: No Yes READMISSION Readmission <=30 Days from Date of Procedure: No Yes ↓ Reason for Readmission: Anticoagulant Complication No Yes Valve Dysfunction No Yes Deep sternal infection No Yes Pericardial Effusion/Tamponade No Yes CHF No Yes Leg infection No Yes MI / Recurrent Angina No Yes renal failure No Yes Arrhythmia No Yes Reop for bleeding No Pneumonia No Yes Heart blockYes CVA permanent No No Yes Re-op for graft occlusion No Yes Yes Permanent Pace-maker insertion No Yes cardiac catheterisation No Yes TIA No Yes Other No Yes PTCA No Yes Acute vascular complication No Stent No Yes Yes FOLLOW-UP Date Last Seen __ __/__ __/__ __ __ __ (mm/dd/yyyy) Alive: NYHA Status : l ll lll lV CCS Status : 0 l ll lll lV Late Dead: Date of late death__ __/__ __/__ __ __ __ (mm/dd/yyyy) Compiled by Dr Richard Wyse. London, 2000 - 2001. With specific thanks for their help (among many others) to K. Taylor, F. Grover, B. Keogh, F. Roques, B. Bidstrup, B. Ferguson, S. Dziuban, F. Edwards A. Krian, P. Kalmar, S. Takamoto, M. Benedicta-Edwards, P. Sargeant. Modified in order to comply with french administrative requirements.