Cardiac Surgery

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Cardiac Surgery

  1. 1. Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards Consultation Document September 2008 National Clinical Dataset Development Programme (NCDDP) Support Team Information Services Area 74A Gyle Square 1 South Gyle Crescent Edinburgh EH12 9EB Tel: 0131 275 7066 Email to: NCDDPsupportteam@isd.csa.scot.nhs.uk Website: www.clinicaldatasets.scot.nhs.uk/Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 1Consultation Document v1.0
  2. 2. Overview & Background ................................................................................................ 5 Overview ....................................................................................................................... 5 Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards ..................... 5 Background to NCDDP ................................................................................................. 6 Generic Data Standards................................................................................................ 6 Clinical Terminology ...................................................................................................... 7 Date Recording ............................................................................................................. 7Published Data Standards ............................................................................................. 9 Generic and Previously Consulted ................................................................................ 9Data Standards under Development ........................................................................... 12Data Standards Currently undergoing Change Control ............................................ 12Clinical / Care Process ................................................................................................. 13Assessment(s), Examinations(s) and Investigation(s).............................................. 13 1.1 Critical Pre-operative State ................................................................................... 13 1.2 Stage of Chronic Kidney Disease.......................................................................... 13 1.3 Suitable for Surgery/Procedure ............................................................................. 14 1.4 Ventilated Pre-op................................................................................................... 14 1.5 Waist-to-Hip Ratio (WHR) ..................................................................................... 15Finding(s) and Result(s)............................................................................................... 15 2.1 Aorta Pathology..................................................................................................... 16 2.2 Cardiogenic Shock Present................................................................................... 16 2.3 Carotid Bruits Present ........................................................................................... 17 2.4 Catheter/Cannula Type ......................................................................................... 17 2.5 Coronary Artery Findings ...................................................................................... 17 2.6 Device Failure ....................................................................................................... 18 2.7 Device Failure – Reason ....................................................................................... 18 2.8 Diffuse Coronary Disease ..................................................................................... 18 2.9 Extracardiac Arteriopathy ...................................................................................... 19 2.10 FEV1 Less Than 50% Predicted ......................................................................... 19 2.11 Gp (Glycoprotein) IIb/IIIA Inhibitor Administered................................................. 20 2.12 Gp (Glycoprotein) IIb/IIIA Inhibitor Reason used................................................. 20 2.13 Gp (Glycoprotein) IIb/IIIA Inhibitor Reason Not Used ......................................... 20 2.14 Heart Valve Disease Aetiology............................................................................ 21 2.15 Heart Value Dysfunction – Type.......................................................................... 21 2.16 Indication for PCI (Percutaneous Coronary Intervention).................................... 22 2.17 Intra-aortic Balloon Pump (IABP) Reason Used ................................................. 22 2.18 Left Ventricular End Diastolic Pressure............................................................... 23 2.19 Left Ventricular Function ..................................................................................... 23 2.20 Lesion Type......................................................................................................... 24 2.21 Long Term Use of Steroids or Bronchodilators ................................................... 24 2.22 Mean Pulmonary Artery Wedge Pressure (PAWP) ............................................. 25 2.23 MRSA Screening................................................................................................. 25 2.24 Myocardial Infarction Classification ..................................................................... 25 2.25 Operative Stage .................................................................................................. 26 2.26 Post Infarct Ventricular Septal Rupture ............................................................... 27 2.27 Primary wound Re-exploration ............................................................................ 27 2.28 Primary Wound Re-exploration Reason.............................................................. 27 2.29 Pulmonary Artery Systolic Pressure.................................................................... 28 2.30 Rapidity of Onset of Valve Dysfunction ............................................................... 28 2.31 Stenosis Diameter Range ................................................................................... 28 2.32 Thrombolysis Treatment...................................................................................... 29 2.33 TIMI (Thrombolysis in Myocardial Infarction) Flow Code .................................... 29Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 2Consultation Document v1.0
  3. 3. Care Planning, Management and Outcome(s) ........................................................... 30 3.1 Chest Drains - Total Number................................................................................. 30 3.2 Drainage – Output ................................................................................................. 30 3.3 Surgical Cover - Type Available ........................................................................... 30Treatment(s) and Intervention(s)................................................................................. 31 4.1 Aorta Procedure .................................................................................................... 32 4.2 Aorta Section......................................................................................................... 32 4.3 Aortic Clamp Type................................................................................................. 32 4.4 Aortic Clamp Used ................................................................................................ 33 4.5 Atrial Ablation Lesion Set ...................................................................................... 33 4.6 Blood Conservation – Method ............................................................................... 34 4.7 Cardiac Incision Type............................................................................................ 34 4.8 Cardiac Incision Site.............................................................................................. 35 4.9 Cardiac Valve Procedure ...................................................................................... 35 4.10 Cardiac Valve(s) replaced/repaired – Total Number ........................................... 36 4.11 Cardioplegia Infusion........................................................................................... 36 4.12 Cardioplegia Solution .......................................................................................... 36 4.13 Cardioplegia Temperature................................................................................... 37 4.14 Cardiopulmonary Bypass Conversion ................................................................. 37 4.15 Cardiopulmonary Bypass Used........................................................................... 37 4.16 Circulatory Support.............................................................................................. 38 4.17 Conduit Anastomotic Device ............................................................................... 38 4.18 Coronary Shunt Size ........................................................................................... 39 4.19 Coronary Shunt Used.......................................................................................... 39 4.20 Coronary Stabiliser Type..................................................................................... 39 4.21 Coronary Stabiliser Used .................................................................................... 40 4.22 CPB (Cardiopulmonary Bypass) Arterial Cannulation......................................... 40 4.23 CPB (Cardiopulmonary Bypass) Venous Cannulation ........................................ 40 4.24 Follow on PCI (Percutaneous Coronary Intervention) Procedure ....................... 41 4.25 Graft Conduit ....................................................................................................... 41 4.26 Haemostatic Method ........................................................................................... 42 4.27 Heart Valve(s) ..................................................................................................... 42 4.28 Intra-aortic balloon pump (IABP) Used................................................................ 43 4.29 Left Main Stem Protected.................................................................................... 43 4.30 Myocardial Protection - Predominant Method .................................................... 43 4.31 Nature of Cardiac Diagnostic Procedure............................................................. 44 4.32 Nature of PCI (Percutaneous Coronary Intervention) Procedure ........................ 44 4.33 Non Cardioplegic Myocardial Protection Method ................................................ 45 4.34 PCI (Percutaneous Coronary Intervention) Adjunctive Device(s) ....................... 45 4.35 Proximal Vascular Anastomoses......................................................................... 46 4.36 Renal Replacement Therapy............................................................................... 47 4.37 Renal Replacement Therapy – Type................................................................... 47 4.38 Simultaneous Procedure ..................................................................................... 47 4.39 Stent Implanted ................................................................................................... 48 4.40 Thoracic and Vascular Procedure ....................................................................... 48 4.41 Valve Type .......................................................................................................... 48 4.42 Vascular Anastomosis Type................................................................................ 49Care Journey and Encounter....................................................................................... 50 5.1 Cardiac Surgery Status ......................................................................................... 50 5.2 Hospital area ......................................................................................................... 50Date(s) and Time(s)....................................................................................................... 51 6.1 Date/Time to Initial PCI Device ............................................................................. 51Appendix 1 – Cardiac Post Op Complication(s) ........................................................ 52 Cardiac Post Op Complication(s) ................................................................................ 52Appendix 2- Working Group ........................................................................................ 56Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 3Consultation Document v1.0
  4. 4. Membership of the Cardiac Surgery & Percutaneous Cardiac Interventions Working Group .................................................................................................................................... 56Appendix 3- Consultation Distribution List ................................................................ 57Appendix 4 – Cardiac Surgery & Percutaneous Cardiac Interventions - Proposed ChangeControl Data Items ........................................................................................................ 59Appendix 5 – Consultation Response ........................................................................ 73 Cardiac Surgery & Percutaneous Cardiac Interventions Consultation Response....... 73Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 4Consultation Document v1.0
  5. 5. Overview & BackgroundOverviewThe National Advisory Committee for CHD (NACCHD) commissioned the development ofCardiac Surgery & Percutaneous Cardiac Interventions Data Standards for NHS Scotland inorder to ensure a national approach to the collection of clinical and non-clinical data itemsrelating to Cardiac Surgery & Percutaneous Cardiac Interventions. The aim is to support theimplementation of an electronic integrated health record, and ensure inter-compatibility ofnational clinical information systems. A Clinical Working Group was established in December2007 to progress this work, supported by the National Clinical Dataset Programme (NCDDP)Support Team in Information Services (ISD).The Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards will: Define common data items recommended for collection in a wide variety of clinical settings. Support the exchange of patient information between healthcare providers. Support the consistent recording of patient information throughout NHS Scotland.It is important to emphasise that these are data standards rather than a dataset. This meansthat the individual data standards included in this document need not all be recorded together inclinical systems but, where it is considered appropriate to record a particular item as part of aperson’s care record, it should be recorded in accordance with the nationally agreed standard.The data standards contain data items from Generic Data Standards and other ClinicalDatasets, which have previously been developed through the NCDDP and are freely available inthe Clinical Datasets section of the web-based Health and Social Care Data Dictionary.We are now seeking feedback from the wider clinical community in order to ensure that thesedata standards are fit for purpose. We invite all interested organisations and individuals to takepart in this consultation by completing the attached Consultation Response Form and thenreturning it to NCDDPsupportteam@isd.csa.scot.nhs.uk. Comments on all or any part of thedocument are welcome.Some background information on the NCDDP and the Cardiac Surgery & Percutaneous CardiacInterventions Data Standards development can be found below. If you have any further queries,please go to our website or contact NCDDPsupportteam@isd.csa.scot.nhs.uk.Cardiac Surgery & Percutaneous CardiacInterventions Data StandardsThe membership of the Cardiac Surgery & Percutaneous Cardiac Interventions Working Groupis shown in Appendix 2. This group agreed the inclusion of individual data items using thefollowing criteria:Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 5Consultation Document v1.0
  6. 6. • Is the data item one which would reasonably be expected to be collected for Cardiac Surgery & Percutaneous Cardiac Interventions? • Is the data item required to prevent duplication of recording? • Is the data item necessary for the on-going health and healthcare of patients receiving Cardiac Surgery & Percutaneous Cardiac Interventions Services? • Is the data item currently shared or likely to be shared in the future, amongst healthcare professionals and key stakeholders?Once consultation is complete the Data Standards will be submitted to the NCDDP ProgrammeBoard for formal approval as a national standard.Once approved the Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards willbe freely and widely available through publication in the Health and Social Care Data Dictionary.Where possible the data standards are UK compatible. It is expected that the Cardiac Surgery &Percutaneous Cardiac Interventions Data Standards will be implemented within existing andemerging national clinical information systems and commercially procured national products, aswell as being available to commercial developers to ensure the ability of their systems tosupport national information requirements.Background to NCDDPThe National Clinical Dataset Development Programme (NCDDP) supports clinicians to developsets of interoperable national datasets to facilitate the implementation of the integrated carerecords across NHS Scotland.These standards will: • Support direct patient care, by reflecting current best practice guidance • Facilitate effective communication between health care professionals • Improve data quality and support secondary data requirements where possible including data to support clinical governance • Be freely and widely available through publication in the web based Health & Social Care Data Dictionary • Incorporate agreed national clinical definitions and implement national terminology • Be UK compatible where possibleThe Chief Medical Officer established the programme in 2003 to support clinicians developingnational clinical data standards, initially to support the national priority areas. These standardsare an essential element of the Electronic Health Record, a central aim of the National e-HealthStrategy. More information can be found on our website.Generic Data StandardsData standards which are relevant to all patients and are used across specialties, disciplinesand settings have already been developed by wider Generic Data Standards clinical workinggroups and approved as national data standards for NHS Scotland. The Cardiac Surgery &Percutaneous Cardiac Interventions Data Standards working group identified several genericdata items as appropriate for inclusion in their standards. These data items are indicated next tothe data item name and definition, which are listed in this document for information. The fulldetail of these existing standards are published on the web based Health and Social Care DataDictionary.Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 6Consultation Document v1.0
  7. 7. Clinical TerminologyThe strategic standard for clinical terminology in NHS Scotland is SNOMED-Clinical Terms. Thismeans that over the next few years, clinical information systems will progress to record clinicaldata using this international standard. The NCDDP Support Team will commence developmentof recommended SNOMED CT specifications as part of the data standards and datasets itsupports.Date RecordingIt is good record-keeping practice always to identify the date of recording of any clinicalinformation. It is expected that all clinical information systems should include ‘date stamping’ asstandard functionality; therefore the Cardiac Surgery & Percutaneous Cardiac InterventionsData Standards do not deal with this issue. In many clinical situations, the date of an event,investigation, etc. is required for clinical purposes and should be visible to the health careprofessional. This date may not be the same as the date on which the data are entered ontothe system. In these instances the system must allow the health care professional to enterwhichever date is appropriate. These issues must be addressed during system specification anddevelopment. The date format for storage and management within a system should conform tothe Government Data Standards Catalogue format: CCYY-MM-DD. However, this does not 1preclude entry or display of data on the user interface using the traditional DD-MM-CCYYformat. An example of a date & time in correct format is: 1997-07-16T19:20 +01:00 (CCYY-MM- DDThh:mmTZD) It is recommended that a time should always be recorded with the appropriate date and not on its own, however it may not be necessary to display the date along with the time. This is of particular importance where any calculations or analyses are likely to be performed. Automated times recorded by IT systems should include all elements of the time, i.e. hours, minutes and seconds, and are expected to be actual. Where times are entered manually, it is likely that only the hours and minutes will be required, although in some circumstances only hours may be required. Time or any element of the time (hours, minutes or seconds) may be actual or estimated. In some circumstances only an actual time may be acceptable, whilst in others an estimated time may be allowed. In the latter situation, it may be necessary to identify whether the time recorded is actual or estimated. Times identified as actual may be used in calculations and analyses. Times marked as estimated should be treated with caution and the implications of undertaking any calculations or analyses should be considered in the particular context within which the time is recorded or to be made subsequent use of. Where an estimated time is allowed, the appropriate degree of verification detail required should be decided, again dependent on the context in which it is recorded and how the time is to be used.Government Data Standards Catalogue11. All times must be expressed in the 24 hour clock format, e.g. one minute past midnight is00:01:00.2. Values of any element less than 10 should be entered with a zero in the first position.3. All times for UK transactions/events will be assumed to be GMT.Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 7Consultation Document v1.0
  8. 8. 4. Systems should record whether the time is Coordinated Universal Time or British SummerTime in the “Time zone designator”. This will allow time elapsed to be calculated correctly, forexample for A&E waiting times.Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 8Consultation Document v1.0
  9. 9. Published Data StandardsGeneric and Previously ConsultedPerson Demographic(s) Socio-Environmental Detail(s)Patient Identification LifestylePerson Family Name Current Tobacco and Nicotine Consumption StatusPerson Title Current Physical Activity StatusName Element Position Family CircumstancesPerson Name Status Family History of Coronary Heart DiseasePreferred Name Clinical/Care ProcessPrevious Person Family Name Problem(s) and Issue(s)Person Given Name Symptom Severity (Ischaemic Chest Pain)Person Initials Symptom Severity (Breathlessness) {CHD}Person Preferred Forename Duration (Symptom)Person Name Suffix Symptom PatternCHI Number Symptom OnsetHealth Record Identifier Symptom Description (Pain) {Palliative Care}Address (BS7666) Assessment(s), Examination(s) and Investigation(s)Postcode Body Mass IndexUK Telephone number Heart RateInternet Email Address HeightPerson Birth Date WeightPerson Death Date Waist CircumferencePerson Current Gender Systolic Blood PressurePerson Marital Status Diastolic Blood PressurePerson Sex at birth Anatomical SiteDiversity Exercise Tolerance Test (Investigation)Ethnic Group (Self Assigned) Exercise Tolerance Test Protocol TypePreferred Language Reason for No Exercise Tolerance TestPreferred Communication Method Electrocardiography (Investigation)Interpretation Assistance Indicator Reason for No ElectrocardiographyCarer(s), Care Professional(s), Team(s), EchocardiographyService(s), Organisation(s) or Sector(s) Reason for no EchocardiographySpecified General Medical Practitioner Stress Test MethodRegistered GP Practice CodeGP General Medical Council Number Chest Pain/Discomfort CharacteristicsSpecified General Medical Practitioner Role Chest Pain AetiologyGeneral Practice Registration Status of Patient Finding(s) and ResultsLocation Code Exercise Tolerance Test Total TimeClinic Name Exercise Tolerance Test Abnormal ResultsAssociated Professional Exercise Tolerance Test Cessation ReasonAssociated Professional Identifier Cardiopulmonary Exercise Test Result (Peak VO2)Associated Professional Role Cardiopulmonary Exercise Test Result (Anaerobic Threshold)Associated Professional Employing Organisation ECG Determining Reperfusion TreatmentName Electrocardiography Results {CHD}Associated Professional Employing Organisation Cardiopulmonary Exercise Test Result (RespirationType Exchange Ratio)Referral Source Cardiopulmonary Exercise Test Result (OxygenReferring Specialty Desaturation)Associated Person Electrocardiography Rhythm Abnormal ResultsAssociated Person Role Electrocardiography Lead (12-Lead) RR IntervalAssociated Person Relationship to client/patient (ECG) ResultCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 9Consultation Document v1.0
  10. 10. Finding(s) and Results(Cont..) Finding(s) and Results(Cont..)P Wave (ECG) Result Magnetic Resonance Imaging Scan (Heart) ResultsPR Interval (ECG) Result Magnetic Resonance Imaging Result (Left Ventricular Mass)QRS Duration (ECG) Result Magnetic Resonance Imaging Result (Late Enhancement)QRS Amplitude (ECG) Result Magnetic Resonance Imaging Result (Left Ventricular End - Diastolic Volume)Q Waves (Pathological) (ECG) Result Magnetic Resonance Imaging Result (Left Ventricular End - Systolic Volume)ST Segment Height of Elevation/Depression (ECG) Magnetic Resonance Imaging Scan (Heart) Abnormal ResultsQT Interval (ECG) Result Right ventricular End-Diastolic Dimension(ECHO)ST Segment (ECG) Result Multiple Gated Acquisition (MUGA) Abnormal ResultsT Wave (ECG) Result Ejection Fraction (Heart)Electrocardiography (Signal Averaged) Results Tilt Table Test ResultsHigh Frequency Low Amplitude Duration (ECG) Tilt Table Test Result (Angle of Tilt)ResultRoot Mean Square Voltage of the Terminal 40ms Tilt Table Test Result (Duration)(ECG) ResultQRS Duration (Filtered) (ECG) Result Tilt Table Test Result (Blood Pressure Monitoring Method)Electrocardiography (Ambulatory) Monitoring Exercise CapacityResult (Ventricular Extrasystoles)Electrocardiography (Ambulatory) Monitoring Carotid Sinus Massage (Supine)Result (Longest Pause)Electrocardiography (Ambulatory) Monitoring Carotid Sinus Massage (Standing / Tilted)Result (Electrophysiology)Echocardiogram Results Myocardial Segments (Observed)Echocardiogram Abnormal Results {CHD} Myocardial Segments (Abnormal)Echocardiogram Results (Left Atrium) CHD Probability StatusEchocardiogram Results (Left Atrium) – Diameter Bruce Protocol Treadmill Staging ResultsEchocardiogram Results (Left Atrium) – Volume Pulmonary Function Test ResultEchocardiogram Results (Left Ventricle) Care Planning, Management and Outcome(s)Echocardiogram Results (Left Ventricle) – Regional Reason for No Coronary AngiographyWall Motion ScoreEchocardiogram (Dyssynchrony) Results Coronary Angiography (Investigation)Echocardiogram Results (Left Ventricle) – End Reason for No Myocardial Perfusion ImagingDiastolic DimensionEchocardiogram Results (Left Ventricle) – End Reason for No Referral to Cardiac RehabilitationSystolic DimensionEchocardiogram Results (Significant Valve Level of Surgical/Clinical SupervisionDisease)Echocardiogram Results (Significant Valve Treatment and Intervention(s)Disease) – Aortic Valve GradientEchocardiogram Results (Significant Valve Procedure(Clinical Imaging)Disease) – Aortic Valve Gradient AreaEchocardiogram Results (Significant Valve Care Journey and EncounterDisease) – Mitral Valve Structure AbnormalitiesEchocardiogram Results (Significant Valve Urgency of ReferralDisease) – Endocarditic VegetationsEchocardiogram Results (Significant Valve Reason for ReferralDisease) – Tricuspid Regurgitation VelocityEchocardiogram Results (Significant Valve Referral TypeDisease) – Estimated Peak Pulmonary Artery Referral ResponsePressureCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 10Consultation Document v1.0
  11. 11. Echocardiogram Results (Other Abnormalities) Date(s) and Time(s)Medication and Device(s) DateMedication or Device Name Date and TimeMedication or Device Code Date of ReferralMedication or Device Status Date Referral ReceivedDuration Date First Seen by Associated ProfessionalMedication Dosage Date 1st Appointment CreatedRoute of Administration Dates and Times of Laboratory Processes and ProceduresRisk(s) and Alert(s) Date of Referral for Coronary AngiogramPrevious Angina Date of Coronary AngiogramPrevious Myocardial Infarction Laboratory Investigation(s)Cerebrovascular Disease Group NameHeart Failure Result (Investigation/Test) Phase 1 Biochemistry Investigations/TestHypertension Antimicrobial Agent (Antimicrobial Agent)Diabetes Mellitus Infection Risk StatusPeripheral Vascular Disease Laboratory Investigations – Specimen TypeChronic Kidney Disease Micro-organism Detection ResultAsthma Micro-organism Name (Micro-organism)Hyperlipidaemia Reason for Investigation/Test RequestPrevious Coronary Artery Bypass Graft (CABG) Units (Investigation/Test)Previous Percutaneous Coronary Intervention (PCI) Investigation/Test Name (Investigation/Test)Generic Consent StandardsCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 11Consultation Document v1.0
  12. 12. Data Standards under DevelopmentThe following data standards are currently under development and impact on Cardiac Surgery &Percutaneous Cardiac Interventions.Autoglous Red CellsBlood Loss VolumeBlood Product(s)Cardiac OutputCentral Venous Pressure(CVP)Operative Procedure NameSurgical Position of PatientSurgical Approach/AccessType of DiathermyVolume of Autoglous Red Cells TransfusedUnits of Blood Cross MatchedUnits of Blood/Blood Products TransfusedData Standards Currently undergoing Change ControlThe following data standards have been produced by modifying the existing item that isdisplayed in the Health and Social Care Data Dictionary. Its adoption will mean that changecontrol is required to the existing items. Please refer to Appendix 4 – Cardiac Surgery &Percutaneous Cardiac Interventions - Proposed Change Control Data Items for a comparison ofthe existing and proposed data standard.Admission Type {Mental Health}Cardiac Enzymes/Markers RaisedCardiac Surgery Procedure TypeAdd in date and timeDate/Time of Symptom Onset {ACS}Ejection Fraction – HeartElectrocardiography (Ambulatory) Monitoring Results {Electrophysiology}Method of ReferralPrevious Percutaneous Coronary Intervention (PCI)Referral Source {Generic Referral}Research StatusThe following Data items are applicable to Cardiac Surgery & Percutaneous CardiacInterventions but are undergoing change control via the Operating Theatres Phase II DataStandards Development.Anaesthetic and/or Sedation TypeDates and Times of Theatre Processes and Operating ProceduresRoute of AdministrationCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 12Consultation Document v1.0
  13. 13. Clinical / Care ProcessAssessment(s), Examinations(s) and Investigation(s) Data Item Number Critical Pre-operative state 1.1 Stage of Chronic Kidney Disease 1.2 Suitable for Surgery/Procedure 1.3 Ventilated Pre Op 1.4 Waist-to-Hip Ratio 1.51.1 Critical Pre-operative StateDefinition: The patient’s immediate state in the pre-operative period.Format: CharactersField length: 2Codes and values: Code Value Explanatory Note 00 Not Critical 01 Critical The patient would be classed as Critical Pre-operative if they have experienced one or more of the following; ventricular tachycardia, fibrillation, aborted sudden death, pre-operative cardiac massage, pre-operative ventilation before arrival in the anaesthetic room, pre operative inotropic support, intra-aortic balloon counterpulsation or preoperative acute renal failure (anuria or oliguiria <10ml/h).Related Data Item(s): Aorta Section, Associated Professional Role, Cardiac Procedure Type,Cardiac Surgery Status, Date, Date of Birth, Diagnosis, Extracardiac Arteriopathy, FEV 1 LessThan 50% Predicated, Intra-aortic balloon pump (IABP) used, Left Ventricular Function, LongTerm Use of Steroids or Bronchodilators, Person Gender, Post Infract Ventricular SeptalRupture, Pulmonary Artery Systolic Pressure, Suitable for Surgery/Procedure, Thoracic andVascular Procedures.Further Information: The above Related Data Items may be used to record the information tocalculate the Euroscore risk assessment.1.2 Stage of Chronic Kidney DiseaseDefinition: The stage of Chronic Kidney Disease.Format: CharactersCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 13Consultation Document v1.0
  14. 14. Field length: 2Codes and values: Code Value Explanatory Note 01 Stage 1 Kidney damage with normal or high eGFR 90mL/min or more 02 Stage 2 Kidney damage and mild decrease in eGFR 60-89mL/min or more 03 Stage 3 Moderate decrease in eGFR 30-59mL/min 04 Stage 4 Severe decrease in eGFR 15 to 29mL/min 05 Stage 5 Established Renal Failure(ERF) eGFR less than 15mL/minRelated Data Item(s): Date, Diagnosis, Renal Replacement Therapy, Renal ReplacementTherapy – Type.1.3 Suitable for Surgery/ProcedureDefinition: An indication of whether the patient is deemed suitable for surgery.Format: CharactersField Length: 2Codes and Values:Code Value00 Not Suitable01 Suitable99 Not KnownRelated Data Item(s): Aorta Section, Associated Professional Role, Cardiac Procedure Type,Cardiac Surgery Status, Critical Pre-Operative State, Date, Date of Birth, Diagnosis,Extracardiac Arteriopathy, FEV 1 Less Than 50% Predicated, Left Ventricular Function, LongTerm Use of Steroids or Bronchodilators, Person Gender, Post Infract Ventricular SeptalRupture, Pulmonary Artery Systolic Pressure, , Thoracic and Vascular Procedures.Further Information: The above Related Data Items may be used to record the information tocalculate the Euroscore risk assessment.1.4 Ventilated Pre-opDefinition: A record of whether the patient was ventilated pre-operatively.Format: CharactersField length: 2Codes and values: Code Value 00 No 01 Yes 99 Not knownRelated Data Item(s): Cardiac Procedure Type, Hospital area.Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 14Consultation Document v1.0
  15. 15. 1.5 Waist-to-Hip Ratio (WHR)Source of Information: Derived from the Centres for Disease Control and Prevention (CDC).Definition: Waist-to-Hip Ratio (WHR) is the ratio of the waist circumference to the hipcircumference.Format: Numeric (n.nnn)Field length: 5Related Data Item(s): Body Mass Index, Height, Person Current Gender, Weight,Further Information:WHR is not intended for children and those individuals who are less than five feet in height orthose who have a body mass index (BMI) of 35 or above.Waist Circumference is the distance around the smallest area of the waist, usually just abovethe belly buttonHip Circumference is the distance around the largest area of the hips, usually the widest part ofthe buttocks.Finding(s) and Result(s) Data Item Number Aorta Pathology 2.1 Cardiogenic Shock Present 2.2 Carotid Bruits Present 2.3 Catheter/Cannula Type 2.4 Coronary Artery Findings 2.5 Device Failure 2.6 Device Failure-Reason 2.7 Diffuse Coronary Disease 2.8 Extracardiac Arteriopathy 2.9 FEV1 less than 50% Predicted. 2.10 Gp (Glycoprotein) IIb/IIIA Inhibitor Administered 2.11 Gp (Glycoprotein) IIb/IIIA Inhibitor Reason used 2.12 Gp (Glycoprotein) IIb/IIIA Inhibitor Reason Not Used 2.13 Heart Valve Disease Aetiology 2.14 Heart Valve Dysfunction-Type 2.15 Indication for PCI (Percutaneous Coronary Intervention) 2.16 Intra-aortic Balloon Pump (IABP) Reason Used 2.17 Left Ventricular End Diastolic Pressure 2.18 Left Ventricular Function 2.19 Lesion Type 2.20 Long Term use of Steroids or Bronchodilators 2.21 Mean Pulmonary Artery Wedge Pressure (PAWP) 2.22 MRSA Screening 2.23 Myocardial Infarction Classification 2.24 Operative Stage 2.25 Post Infarct Ventricular Septal Rupture 2.26 Primary Wound Re-exploration 2.27Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 15Consultation Document v1.0
  16. 16. Primary Wound Re-exploration Reason 2.28 Pulmonary Artery Systolic Pressure 2.29 Rapidity of onset of Valve dysfunction 2.30 Stenosis Diameter Range 2.31 Thrombolysis Treatment 2.32 TIMI (Thrombolysis in Myocardial Infarction) Flow Code 2.332.1 Aorta PathologyDefinition: The type of pathological involvement of the aorta.Format: CharactersField Length: 3Codes and Values: Code Value Sub Codes Sub Values 01 Aneurysm 02 Syphilis 03 Dissection 04 Transection 05 Coarctation 06 Atheroma 07 Marfan’s Syndrome 08 Mycosis 09 Congenital 10 Infection A Native infection B Graft infection 12 Other Connective Tissue Disorder 98 Other (specify) 99 Not KnownRelated Data Item(s): Aorta Procedure, Aorta Section, Cardiac Procedure Type, Cardiac ValveProcedure.Recording Guidance: Users may wish to augment code 98 – “Other (specify)” with a free textfield for recording other findings.2.2 Cardiogenic Shock PresentDefinition: A record of whether the patient has evidence of tissue hypoperfusion in the contextof elevated left ventricular filling pressure.Format: CharactersField length: 2Codes and values: Code Value 00 No 01 Yes 99 Not KnownCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 16Consultation Document v1.0
  17. 17. Related Data Item(s): Catheter/Cannula Type, Diastolic Blood Pressure, Left Ventricular EndDiastolic Pressure, Operative Stage, Systolic Blood Pressure.2.3 Carotid Bruits PresentDefinition: A record of the presence of carotid bruits on auscultation.Format: CharactersField length: 2Codes and values: Code Value 00 No 01 Yes 99 Not Known2.4 Catheter/Cannula TypeDefinition: The type of catheter/cannula used.Format: CharactersField length: 2Codes and Values: Code Value Explanatory note 01 Pulmonary Artery Flotation Catheter Swan Ganz 02 Central Venous Catheter Central Venous Line 03 Epidural Catheter 04 Urinary Catheter 05 Radial Artery Cannula Arterial Line 06 Peripheral Venous Cannula 98 Other 99 Not KnownRelated Data Item(s): Anatomical Site, Associated Professional Role, Cardiac Procedure Type.2.5 Coronary Artery FindingsDefinition: The state of the Coronary Artery.Format: CharactersField length: 2Codes and values: Code Value 01 CalcifiedCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 17Consultation Document v1.0
  18. 18. 02 Diseased 03 Dissected 04 Healthy 05 Thrombus 98 Other 99 Not KnownRelated Data Item(s): Diagnosis, Proximal Vascular Anastomoses, Vascular AnastomosisType.Recording Guidance: IT systems should allow for multiple recordings.2.6 Device FailureDefinition: A record of whether the device failed.Format: CharactersField length: 2Codes and values: Code Value 00 No 01 Yes 99 Not KnownRelated data item(s): Device failure – Reason, Operative Stage, PCI (Percutaneous CoronaryIntervention) Adjunctive Device(s).2.7 Device Failure – ReasonCommon Name: Reason for Device FailureDefinition: The reason for the device failure.Format: CharactersField length: 2Codes and Values: Code Value 01 Iatrogenic 02 Intrinsic 99 Not KnownRelated data item(s): Device failure, PCI (Percutaneous Coronary Intervention) AdjunctiveDevice(s).2.8 Diffuse Coronary DiseaseDefinition: A record of whether diffuse coronary disease is present.Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 18Consultation Document v1.0
  19. 19. Format: CharactersField length: 2Codes and values: Code Value 00 No 01 Yes 99 Not knownRelated Data Items: Coronary Artery Findings.2.9 Extracardiac ArteriopathyDefinition: A record of evidence of arterial disease outwith the coronary circulation.Format: CharactersField length: 2Codes and values: Code Value 00 No 01 Yes 99 Not KnownRelated Data Item(s): Aorta Section, Associated Professional Role, Cardiac Procedure Type,Cardiac Surgery Status, Critical Pre-Operative State, Date, Date of Birth, Diagnosis, FEV 1 LessThan 50% Predicated, Left Ventricular Function, Long Term Use of Steroids or Bronchodilators,Person Gender, Post Infract Ventricular Septal Rupture, Pulmonary Artery Systolic Pressure, ,Suitable for Surgery/Procedure, Thoracic and Vascular Procedures.Further Information: The above Related Data Items may be used to record the information tocalculate the Euroscore risk assessment.2.10 FEV1 Less Than 50% PredictedDefinition: A record of whether FEV1 is less than 50% predictedFormat: CharactersField length: 2Codes and values: Code Value 00 No 01 Yes 99 Not KnownRelated Data Item(s): Aorta Section, Associated Professional Role, Date of Birth, CardiacProcedure Type, Cardiac Surgery Status, Critical Pre-Operative State, Date, Diagnosis, FEV 1Less Than 50% Predicated, Left Ventricular Function, Long Term Use of Steroids orCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 19Consultation Document v1.0
  20. 20. Bronchodilators, Person Gender, Pulmonary Artery Systolic Pressure, Post Infract VentricularSeptal Rupture, Pulmonary Function Test, Pulmonary Function Test Result, Suitable forSurgery/Procedure, Thoracic and Vascular Procedures.Further Information: The above Related Data Items may be used to record the information tocalculate the Euroscore risk assessment.2.11 Gp (Glycoprotein) IIb/IIIA Inhibitor AdministeredDefinition: A record of whether Gp (Glycoprotein) IIb/IIIA Inhibitor was administered.Format: CharactersField length: 2Codes and values: Code Value 00 No 01 Yes 99 Not KnownRelated data item(s): Gp (Glycoprotein) IIb/IIIA Inhibitor Reason used, Gp (Glycoprotein)IIb/IIIA Inhibitor Reason not used.2.12 Gp (Glycoprotein) IIb/IIIA Inhibitor Reason usedDefinition: The reason why Gp (Glycoprotein) IIb/IIIA Inhibitor was usedFormat: CharactersField length: 2Codes and values: Code Value Explanatory Note 01 High Risk Clinical Presentation e.g. ACS 02 High Risk procedure e.g. Multiple stents deployed, bifurcation stenting, LMS stenting 03 Poor Visual Result Intra-coronary thrombus/ <TIMI III flow in target vesselRelated data item(s): Gp (Glycoprotein) IIb/IIIA Inhibitor Administered.2.13 Gp (Glycoprotein) IIb/IIIA Inhibitor Reason Not UsedDefinition: The reason why Gp (Glycoprotein) IIb/IIIA Inhibitor was not used.Format: CharactersField length: 2Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 20Consultation Document v1.0
  21. 21. Codes and values: Code Value Explanatory Note 01 Good result in low risk patient 02 Recent Lysis (<24hrs) Recent thrombolysis (within 24 hours) 03 Recent haemorrhagic problem 04 Haematological contraindication 05 Previous adverse reaction 98 Other 99 Not KnownRelated data item(s): Gp (Glycoprotein) IIb/IIIA Inhibitor Administered.2.14 Heart Valve Disease AetiologyDefinition: The cause of native or prosthetic valve disease.Format: CharactersField Length: 3Codes and Values: Code Value Sub Sub Values Code 01 Congenital 02 Degenerative 03 Infection A Active Endocarditis B Previous Endocarditis Z Other 04 Rheumatic 05 Annuloaortic Ectasia 06 Calcific Degeneration 07 Ischaemic 08 Functional Regurgitation 09 Thrombosis 10 Dehiscence 11 Embolism 12 Intrinsic Valve Failure 13 Haemolysis 98 Other 99 Not KnownRelated Data Item(s): Cardiac Procedure Type, Heart Valve(s), Valve Type.Recording Guidance: IT systems should allow for multiple recordings.2.15 Heart Value Dysfunction – TypeDefinition: A record of the type of haemodynamic dysfunction of the heart valve.Format: CharactersCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 21Consultation Document v1.0
  22. 22. Field Length: 2Codes and Values: Code Value 01 Stenosis 02 Regurgitation 03 Mixed 99 Not KnownRelated Data Item(s): Heart Valve(s), Pulmonary Artery Wedge Pressure (PAWP).Recording guidance: IT Systems should allow for multiple recordings.2.16 Indication for PCI (Percutaneous Coronary Intervention)Main Source of Standard: Derived from BCIS (British Cardiovascular Intervention Society)Definition: The clinical indication for PCI (Percutaneous Coronary Intervention) beingperformed.Format: CharactersField length: 3Codes and values: Code Value Sub Sub Value Explanatory Notes code 01 Acute Coronary A Unstable Angina Syndrome B Non ST elevation myocardial infarction C ST segment elevation myocardial infarction 02 Stable Angina Stable patients with symptomatic or silent ischaemia. 03 Stable coronary Stable patients without angina /LV anatomy because PCI believed to offer prognostic benefit or would improve ventricular function to include PCI for arrhythmia. 98 Other 99 Not KnownRelated Data Item(s): Chest Pain Aetiology, Echocardiogram Results, Electrocardiography(Investigation), Electrocardiography Lead (12 Lead), Nature of Cardiac Diagnostic Procedure,Nature of PCI (Percutaneous Coronary Intervention) Procedure,Recording guidance: IT systems should allow for multiple recordings.2.17 Intra-aortic Balloon Pump (IABP) Reason UsedDefinition: Reason for use of intra-aortic balloon pump.Format: CharactersCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 22Consultation Document v1.0
  23. 23. Field length: 2Codes and values: Code Value 01 Haemodynamic Instability 02 Unstable angina 03 CPB Wean 04 Prophylactic 98 Other 99 Not KnownRelated Data Item(s): Cardiopulmonary Bypass Used, Chest Pain Aetiology, ChestPain/Discomfort Characteristics, Echocardiogram Results (Left Ventricle) Ejection Fraction(Heart), Electrocardiography (Investigation), Heart Rate, Intra-aortic balloon pump (IABP) used,Mean Pulmonary Artery Wedge Pressure, Operative Stage.2.18 Left Ventricular End Diastolic PressureDefinition: A record of the left ventricular end diastolic pressure as measured in millimetres ofmercury.Format: Numeric (nnn)Field length: 3Codes and values: N/ARelated Data Item(s): Echocardiography (Investigation), Echocardiogram Investigation Type,Echocardiogram Results2.19 Left Ventricular FunctionDefinition: The function of the left ventricle based on ejection fraction.Format: CharactersField length: 2Codes and values: Code Value Explanatory Note 01 Normal LVEF>=50% 02 Moderately Impaired LVEF 30-49% 03 Severely Impaired LVEF <30% 99 Not Known Not MeasuredRelated Data Item(s): Aorta Section, Associated Professional Role, Cardiac Procedure Type,Cardiac Surgery Status, Critical Pre-Operative State, Date, Date of Birth, Diagnosis,Echocardiogram Results (Left Ventricle), Ejection Fraction (Heart), Extracardiac Arteriopathy,FEV 1 Less Than 50% Predicated, Intra-aortic balloon pump (IABP) used, Long Term Use ofSteroids or Bronchodilators, Magnetic Resonance Imaging Scan (Heart) Abnormal Results,Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 23Consultation Document v1.0
  24. 24. Person Gender, Post Infract Ventricular Septal Rupture, Pulmonary Artery Systolic Pressure,Suitable for Surgery/Procedure, Thoracic and Vascular Procedures.Further Information: The above Related Data Items may be used to record the information tocalculate the Euroscore risk assessment.2.20 Lesion TypeDefinition: The type of lesion.Format: CharactersField length: 2Codes and values: Code Value Explanatory Notes 01 Denovo Lesion 02 Re-stenosis of angioplasty 03 In stent re-stenosis 04 Chronic Total Occlusion Greater than 3 months 05 Bifurcation lesion 98 Other 99 Not KnownRelated data item(s): Anatomical site, Stent Implanted.Recording Guidance: IT systems should allow for multiple recordings.This may be linked to the specific manufacturer/device code.2.21 Long Term Use of Steroids or BronchodilatorsDefinition: : A record of whether there is current long term (more than 6 months) use ofsteroids or bronchodilators.Format: CharactersField length: 2Codes and values: Code Value 00 No 01 Yes 99 Not KnownRelated Data Item(s): Aorta Section, Associated Professional Role, Cardiac Procedure Type,Cardiac Surgery Status, Critical Pre-Operative State, Date, Date of Birth, Diagnosis,Echocardiogram Results (Left Ventricle), Ejection Fraction (Heart), Extracardiac Arteriopathy,FEV 1 Less Than 50% Predicated, Intra-aortic balloon pump (IABP) used, Left VentricularFunction, Magnetic Resonance Imaging Scan (Heart) Abnormal Results, Person Gender, PostInfract Ventricular Septal Rupture, Pulmonary Artery Systolic Pressure, Suitable forSurgery/Procedure, Thoracic and Vascular Procedures.Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 24Consultation Document v1.0
  25. 25. Further Information: The above related data items may be used to record the information tocalculate the Euroscore risk assessment.2.22 Mean Pulmonary Artery Wedge Pressure (PAWP)Definition: A record of the mean pulmonary artery wedge pressure as an estimation of leftatrial pressure as measured in millimetres of mercury.Format: Numeric (nnn)Field length: 3Codes and values: N/ARelated Data Item(s): Cardiac Procedure Type, Catheter/Cannula Type.2.23 MRSA ScreeningDefinition: A record of whether MRSA Screening was undertaken.Format: CharactersField length: 2Codes and Values: Code Value 00 No 01 Yes 99 Not KnownRelated Data Item(s): Anatomical Site, Antimicrobial Agent (antimicrobial Agent), InfectionRisk Status, Investigation/Test Name (Investigation/Test), Laboratory Investigations – SpecimenType, Medication or Device Code, Medication or Device Name, Micro-organism detection result,Micro-organism Name (Micro-organism), Reason for Investigation/Test Request, Units(Investigation/Test).2.24 Myocardial Infarction ClassificationMain source of Item: European Society of Cardiology Classification of Myocardial InfarctionDefinition: The type of myocardial infarction.Format: CharactersField length: 2Codes and values: Code Value Explanatory Note 01 Type 1 Spontaneous Myocardial infarction related to ischaemia due to a primaryCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 25Consultation Document v1.0
  26. 26. coronary event such as plaque erosion and/or rupture, fissuring, or dissection. 02 Type 2 Myocardial Infarction Secondary to ischaemia due to either increased oxygen demand or decreased supply, e.g. coronary artery spasm, coronary embolism, anaemia, arrhythmias, hypertension or hypotension. 03 Type 3 Sudden expected cardiac death, including cardiac arrest, often with symptoms suggestive of myocardial ischaemia, accompanied by presumably new ST elevation, or new LBBB, or evidence of fresh thrombosis in a coronary artery by angiography and/or autopsy, but death occurring before blood samples could be obtained, or at a time before the appearance of biomarkers in the blood. 04 Type 4a Myocardial infarction associated with PCI. 05 Type 4b Myocardial infarction associated with stent thrombosis as documented by angiography or at autopsy. 06 Type 5 Myocardial infarction associated with CABG.Related Data Item(s): Cardiac Procedure Type, Chest Pain Aetiology, Date/Time of symptomonset, Diagnosis, ECG Determining Reperfusion Treatment, Electrocardiography(Investigation), Electrocardiography Results, Indication for PCI (Percutaneous CoronaryIntervention), Nature of Cardiac Diagnostic Procedure, Nature of PCI (Percutaneous CoronaryIntervention) Procedure.2.25 Operative StageDefinition: Indicates the operative stage.Format: CharactersField Length: 3Codes and values: Code Value Sub Sub Value Explanatory Note Code 01 Pre The period prior to the commencement of a procedure (e.g. Anaesthesia/surgery) 02 Intra The period during the active procedure (e.g. anaesthesia/surgery) 03 Post The period following conclusion of the procedure (e.g. anaesthesia/surgery) A Immediate Post Within 24 hours of the Operative procedure ending B Late Post The 24 hours following Operative the immediate post op stage 98 Other 99 Not KnownRelated Data Item(s): Cardiac Procedure Type.Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 26Consultation Document v1.0
  27. 27. 2.26 Post Infarct Ventricular Septal RuptureDefinition: A record of whether the patient had a ventricular septal rupture following myocardialinfarction.Format: CharactersField length: 2Codes and values: Code Value 00 No 01 Yes 99 Not KnownRelated Data Item(s): Aorta Section, Associated Professional Role, Cardiac Procedure Type,Cardiac Surgery Status, Critical Pre-Operative State, Date, Date of Birth, Diagnosis,Extracardiac Arteriopathy, FEV 1 Less Than 50% Predicated, Intra-aortic balloon pump (IABP)used, Left Ventricular Function, Long Term Use of Steroids or Bronchodilators, Person Gender,Pulmonary Artery Systolic Pressure, Suitable for Surgery/Procedure, Thoracic and VascularProcedures.Further Information: The above related data items may be used to record the information tocalculate the Euroscore risk assessment.2.27 Primary wound Re-explorationDefinition: A record of whether the patient required re- exploration of the primary incisionduring the same admission.Format: CharactersField length: 2Codes and values: Code Value 00 No 01 Yes 99 Not knownRelated Data Item(s): Cardiac Procedure Type, Primary Wound Re-exploration Reason.2.28 Primary Wound Re-exploration ReasonDefinition: Reason for primary wound re-exploration.Format: CharactersField length: 2Codes and values: Code ValueCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 27Consultation Document v1.0
  28. 28. 01 Bleeding 02 Tamponade 03 Cardiac arrest 04 Valvular problems 05 Graft Problems 98 Other 99 Not KnownRecording Guidance: IT systems should allow for multiple recordings.2.29 Pulmonary Artery Systolic PressureDefinition: A record of the pulmonary artery systolic pressure as measured in millimetres ofmercury.Format: Numeric (nnn)Field length: 3Codes and values: N/ARelated data item(s): Echocardiogram Results, Echocardiography (Investigation).2.30 Rapidity of Onset of Valve DysfunctionDefinition: The rapidity of onset of the valvular dysfunction.Format: CharactersField length: 2Codes and Values: Code Value Explanatory Note 01 Acute Acute Sudden onset 02 Chronic Long StandingRelated Data Item(s): Diagnosis, Heart Valve Dysfunction.2.31 Stenosis Diameter RangeDefinition: The percentage (%) range of stenosis present in an artery or branch.Format: CharactersField length: 2Codes and values: Code Value 01 0% 02 1-49% 03 50-74%Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 28Consultation Document v1.0
  29. 29. 04 75-94% 05 95-99% 06 100% 99 Not KnownRelated Data Item(s): Anatomical Site, Operative Stage, TIMI (Thrombolysis in MyocardialInfarction) Flow Code.2.32 Thrombolysis TreatmentDefinition: A record of whether the patient received thrombolytic treatment.Format: CharactersField length: 2Codes and values: Code Value 00 No 01 Yes 99 Not knownRelated data item(s): Date and Time, Medication Dosage, Medication or Device Code,Medication or Device Name, Route of Administration.Recording Guidance: IT systems should flag if thrombolytic treatment has been given lessthan 30 days prior.2.33 TIMI (Thrombolysis in Myocardial Infarction) Flow CodeDefinition: A record of coronary blood flow in the artery relevant to the infarct.Format: CharactersField length: 2Codes and values: Code Value Explanatory Notes 00 TIMI 0 No flow down vessel 01 TIMI 1 Some flow down vessel but does not reach distally by end of a normal angiographic run 02 TIMI 2 Flow reaches distal vessel by end of a normal angiographic run but flow is much slower than normal 03 TIMI 3 Normal flow 99 Not knownRelated data item(s): Anatomical Site, Nature of Cardiac Diagnostic Procedure, StenosisDiameter Range.Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 29Consultation Document v1.0
  30. 30. Care Planning, Management and Outcome(s) Data Item Number Chest Drains - Total Number 3.1 Drainage Output 3.2 Surgical Cover – Type Available 3.33.1 Chest Drains - Total NumberDefinition: The total number of chest drains inserted.Format: Numeric (nn)Field length: 2Codes and Values: N/ARelated Data Item(s): Anatomical Site, Date and Time.3.2 Drainage – OutputDefinition: Total drainage in millilitres from drainage tubes.Format: Numeric (nnnn)Field length: 4Codes and Values: N/ARelated Data Item(s): Anatomical Site, Cardiac Procedure Type, Chest Drains – TotalNumber, Date and Time, Hospital area.Recording Guidance: IT systems should allow for multiple recordings.3.3 Surgical Cover - Type AvailableDefinition: The type of surgical cover available.Format: CharactersField length: 3Codes and values: Code Value Sub Codes Sub Values Explanatory Note 00 None No cover required 01 Off Site Cover from a hospital performing Cardiac Surgery 02 On Site A Informal On Site Surgeon unaware of intended procedureCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 30Consultation Document v1.0
  31. 31. B Formal On Site Surgeon aware of intended procedure 99 Not KnownRelated data item(s): Associated Professional, Associated Professional Identifier, AssociatedProfessional Role, Location Code.Treatment(s) and Intervention(s) Data Item Number Aorta Procedure 4.1 Aorta Section 4.2 Aortic Clamp Type 4.3 Aortic Clamp Used 4.4 Atrial Ablation Lesion Set 4.5 Blood Conservation-Method 4.6 Cardiac Incision Primary/Secondary 4.7 Cardiac Incision Type 4.8 Cardiac Valve Procedure 4.9 Cardiac Valve(s) Replaced/Repaired-Total Number 4.10 Cardioplegia Infusion 4.11 Cardioplegia Solution 4.12 Cardioplegia Temperature 4.13 Cardiopulmonary Bypass Conversion 4.14 Cardiopulmonary Bypass Used 4.15 Circulatory Support 4.16 Conduit Anastomotic Device 4.17 Coronary Shunt Size 4.18 Coronary Shunt Used 4.19 Coronary Stabiliser Type 4.20 Coronary Stabiliser Used 4.21 CPB (Cardiopulmonary Bypass) Arterial Cannulation 4.22 CPB (Cardiopulmonary Bypass) Venous Cannulation 4.23 Follow on PCI (Percutaneous Coronary Intervention) Procedure 4.24 Graft Conduit 4.25 Haemostatic Method 4.26 Heart Valve(s) 4.27 Intra-aortic Balloon Pump (IABP) Used 4.28 Left Main Stem Protected 4.29 Myocardial Protection - Predominant Method 4.30 Nature of Cardiac Diagnostic Procedure 4.31 Nature of PCI (Percutaneous Coronary Intervention) Procedure 4.32 Non Cardioplegic Myocardial Protection Method 4.33 PCI (Percutaneous Coronary Intervention) Adjunctive Device(s) 4.34 Proximal Vascular Anastomoses 4.35 Renal Replacement Therapy 4.36 Renal Replacement Therapy – Type 4.37 Simultaneous Procedure 4.38 Stent Implanted 4.39 Thoracic and Vascular Procedure 4.40 Valve Type 4.41 Vascular Anastomosis Type 4.42Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 31Consultation Document v1.0
  32. 32. 4.1 Aorta ProcedureDefinition: The type of procedure carried out on the aorta.Format: CharactersField Length: 2Codes and Values: Code Value 01 Interposition tube graft 02 Tube graft + separate Aortic Valve Replacement (AVR) 03 Root replacement with composite valve graft and coronary re-implantation 04 Root replacement with preservation of native valve and coronary re- implantation 05 Homograft root replacement 06 Autograft root replacement (Ross Procedure) 07 Aortic patch graft 08 Sinus of Valsalva repair 09 Reduction aortoplasty 98 Other 99 Not KnownRelated Data Item(s): Aorta Section, Aorta Pathology, Cardiac Procedure Type.Recording guidance: IT systems should allow for multiple recordings.4.2 Aorta SectionDefinition: The section of the aorta involved.Format: CharactersField Length: 2Codes and Values: Code Value 01 Root 02 Ascending 03 Arch 04 Descending 05 Abdominal 99 Not KnownRelated Data Items: Aorta Pathology, Aorta Procedure, Cardiac Procedure Type, Thoracic andVascular Procedure.Recording guidance: IT systems should allow for multiple recordings.4.3 Aortic Clamp TypeCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 32Consultation Document v1.0
  33. 33. Definition: The type of aortic clamp.Format: CharactersField length: 2Codes and Values: Code Value 01 Vascular Clamp 02 Endoclamp 03 Transthoracic 98 Other 99 Not KnownRelated Data Item(s): Aortic Clamp Used.4.4 Aortic Clamp UsedDefinition: A record of whether an aortic clamp was used.Format: CharactersField length: 2Codes and Values: Code Value 00 No 01 Yes 99 Not knownRelated Data Item(s): Aorta Section, Cardiac Incision Type, Cardiac Procedure Type, Dateand Time, Echocardiography (Investigation) Echocardiogram Investigation Type.Recording Guidance: IT systems should allow for multiple recordings.4.5 Atrial Ablation Lesion SetDefinition: A record of the Atrial Ablation Lesion Set.Format: CharactersField length: 2Codes and Values: Code Value 01 Pulmonary Vein Isolation Lesion 02 Superior Pulmonary Vein Connecting Lesion 03 Inferior Pulmonary Vein Connecting Lesion 04 Atrial Appendage Connecting Lesion 05 Mitral Valve Lesion 06 Full Atrial Lesion Set including lesions to Tricuspid valve 07 Partial Atrial Lesion SetCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 33Consultation Document v1.0
  34. 34. 98 Other 99 Not KnownAttributes:LeftRightRelated Data Item(s): Ablation Attempt, Ablation Energy Source, Ablation (TechnicalSuccess), Anatomical Site, Diagnosis.Recording Guidance: IT systems should allow for multiple recordings.4.6 Blood Conservation – MethodDefinition: The method used for blood conservationFormat: CharactersField length: 3Codes and values: Code Values Sub Codes Sub Values 01 Drugs A Serine protease inhibitor B Anti-fibrinolytics 02 Mechanical A Auto Transfusion B Pre Donation C Cell Saver 98 Other 99 Not KnownRelated Data Item(s): Blood Product(s), Medication or Device Name, Medication Dosage,Medication or Device Code, Route of Administration.Further Information: A comprehensive list of drugs can be found within the BNFhttp://www.bnf.org/bnf/bnf/current/104945.htm4.7 Cardiac Incision TypeDefinition: The type of incision.Format: CharactersField length: 2Codes and values: Code Value 01 Primary 02 Secondary 99 Not knownRelated Data Item(s): Simultaneous ProcedureCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 34Consultation Document v1.0
  35. 35. 4.8 Cardiac Incision SiteDefinition: A record of the site of the incision.Format: CharactersField length: 3Codes and values: Code Value Sub Code Sub Value 01 Sternotomy A Median Sternotomy B Transverse Sternotomy C Hemi Sternotomy 02 Thoracotomy A Anterolateral Thoracotmy B Posterolateral Thoracotomy 03 Port-access 04 Laparotomy 98 Other 99 Not KnownAttributes:Incision:First TimeRe-doLaterality:LeftRightRelated Data Item(s): Anatomical Site, Cardiac Procedure Type.4.9 Cardiac Valve ProcedureDefinition: A description of the type of procedure performed on the cardiac valve.Format: CharactersField Length: 2Codes and Values: Code Value 01 Replacement 02 Repair 03 Inspection 98 Other 99 Not KnownRelated data item(s): Cardiac Procedure Type, Cardiac Valves Replaced/Repaired – TotalNumber, Heart Valve(s), Heart Valve Disease Aetiology, Valve Type.Recording Guidance: IT systems should allow for multiple recordings.Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 35Consultation Document v1.0
  36. 36. 4.10 Cardiac Valve(s) replaced/repaired – Total NumberCommon Name: Total number of cardiac valve(s) replaced/repaired.Definition: The number of Cardiac valves replaced or repaired.Format: Numeric (nnn)Field Length: 3Codes and values: N/ARelated data item(s): Cardiac Valve Procedure.4.11 Cardioplegia InfusionDefinition: The method by which the cardioplegia solution was infused.Format: CharactersField length: 2Codes and values: Code Value 01 Antegrade 02 Retrograde 03 Antegrade and Retrograde 96 Not applicableAttributes:IntermittentContinuousRelated data item(s): Cardioplegia solution, Cardioplegia temperature, Myocardial Protection– Predominant Method.4.12 Cardioplegia SolutionDefinition: The solution used to achieve myocardial preservation.Format: CharactersField length: 2Codes and values: Code Value 01 Blood 02 Crystalloid 96 Not applicableCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 36Consultation Document v1.0
  37. 37. Related data item(s): Cardioplegia Temperature, Cardioplegia Infusion, Myocardial Protection– Predominant Method.4.13 Cardioplegia TemperatureDefinition: The temperature of cardioplegia solution used to achieve myocardial preservation.Format: CharactersField length: 2Codes and values: Code Value Explanatory Note 01 Cold < 370 C 02 Warm 370 C 96 Not applicableRelated data item(s): Cardioplegia Solution, Cardioplegia Infusion, Myocardial Protection –Predominant Method.4.14 Cardiopulmonary Bypass ConversionDefinition: A record of whether it was necessary to convert to cardiopulmonary bypass duringthe procedure.Format: CharactersField length: 2Codes and values: Code Value 00 No 01 Yes 99 Not knownRelated Data Item(s): Cardiopulmonary Bypass Used, Dates and Times of Theatre Processesand Operative Procedures.4.15 Cardiopulmonary Bypass UsedDefinition: A record of whether cardiopulmonary bypass was used.Format: CharactersField length: 2Codes and values: Code Value 00 No 01 Yes 99 Not knownCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 37Consultation Document v1.0
  38. 38. Related Data Item(s): Cardiopulmonary Bypass Conversion, CPB (Cardiopulmonary Bypass)Arterial Cannulation, CPB(Cardiopulmonary Bypass) Venous Cannulation, Date and Time,Dates and Times of Theatre Processes and Operative Procedures, Temperature.4.16 Circulatory SupportDefinition: The type of circulatory support used.Format: CharactersField length: 3Codes and values: Code Value Sub Codes Sub Values 00 None 01 Intra-aortic balloon pump (IABP) 02 Cardiopulmonary Bypass support (CPS) 03 Ventricular Assist Device (VAD) 04 Inotropes 05 Temporary Pacing A Transvenous Temporary Pacing B External Temporary Pacing 06 External cardiac massage A Non Mechanical (External) B Mechanical 98 Other 99 Not KnownRelated Data Item(s): Intra-aortic balloon pump (IABP) used, Intra-aortic balloon pump (IABP)Reason Used, Operative Stage, Procedure Status.Recording Guidance: IT systems should allow for multiple recordings.4.17 Conduit Anastomotic DeviceDefinition: A record of whether an anastomotic device was used.Format: CharactersField length: 2Codes and values: Code Value 00 No 01 Yes 99 Not knownRelated Data Item(s): Cardiac Procedure Type, Coronary Shunt Used, Graft Conduit, ProximalVascular Anastomoses, Vascular Anastaomosis Type.Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 38Consultation Document v1.0
  39. 39. Recording Guidance: IT Systems should allow for multiple recordings.4.18 Coronary Shunt SizeDefinition: The size of the coronary shunt used as measured in mm.Format: Numeric (n.nn)Field length: 4Codes and Values: N/ARelated Data Item(s): Coronary Shunt Used.Recording Guidance: IT Systems should allow for multiple recordings.4.19 Coronary Shunt UsedDefinition: A record of whether a coronary shunt was used.Format: CharactersField length: 2Codes and values: Code Value 00 No 01 Yes 99 Not knownRelated Data Item(s): Anatomical Site, Cardiac Procedure Size, Conduit Anastomotic Device,Coronary Shunt Size, Proximal Vascular Anastomoses.4.20 Coronary Stabiliser TypeDefinition: The type of coronary stabiliser used.Format: CharactersField length: 2Codes and Values: Code Value 01 Octopus 02 Guidant 98 Other 99 Not KnownRelated Data Item(s): Coronary Stabiliser Used.Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 39Consultation Document v1.0
  40. 40. 4.21 Coronary Stabiliser UsedDefinition: A record of whether coronary stabiliser was used.Format: CharactersField length: 2Codes and Values: Code Value 00 No 01 Yes 99 Not knownRelated Data Item(s): Cardiac Procedure Type, Coronary Stabiliser Type.4.22 CPB (Cardiopulmonary Bypass) Arterial CannulationDefinition: The site of return to the body of oxygenated blood from the cardiopulmonarybypass circuit.Format: CharactersField length: 2Codes and values: Code Value 01 Ascending aorta 02 Femoral artery 03 Subclavian artery 04 Axillary artery 05 Carotid artery 06 Descending aorta 07 Left ventricle 98 Other 99 Not KnownAttributes:LeftRightRelated Data Item(s): Cardiopulmonary Bypass Conversion, Cardiopulmonary BypassProcedure, Cardiopulmonary Bypass Used.4.23 CPB (Cardiopulmonary Bypass) Venous CannulationDefinition: The site of return of blood from the body to the cardiopulmonary bypass circuit.Format: CharactersCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 40Consultation Document v1.0
  41. 41. Field length: 2Codes and values: Code Value 01 Atrium 02 Femoral Vein 03 Internal Jugular Vein 98 Other 99 Not KnownAttributes:LeftRightRelated Data Item(s): Cardiopulmonary Bypass Conversion, Cardiopulmonary BypassProcedure, Cardiopulmonary Bypass Used.4.24 Follow on PCI (Percutaneous Coronary Intervention) ProcedureDefinition: A record of whether PCI (Percutaneous Coronary Intervention) was undertakenfollowing a planned diagnostic angiogram.Format: CharactersField length: 2Codes and values: Code Value 00 No 01 Yes 99 Not knownRelated data item(s): Cardiac Procedure Type, Coronary Angiography (Investigation), PCI(Percutaneous Coronary Intervention) Adjunctive Device(s).4.25 Graft ConduitDefinition: A description of the type of graft conduit used.Format: CharactersField Length: 2Codes and values: Code Value 01 Pedicle Internal Mammary Artery 02 Pedicle Gastroepiploic Artery 03 Free Internal Mammary Artery 04 Free Gastroepiploic Artery 05 Radial artery 06 Long Saphenous Vein 07 Short Saphenous VeinCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 41Consultation Document v1.0
  42. 42. 08 Cephalic vein 98 Other (specify) 99 Not KnownAttributes:LateralityRightLeftBilateralRelated Data Item(s): Anatomical Site, Cardiac Procedure Type, Conduit Anastomotic Device,Procedure Status, Proximal Vascular Anastomoses, Vascular Anastomosis Type.Recording Guidance: Users may wish to augment code 98 – “Other (specify)” with a free textfield.4.26 Haemostatic MethodCommon Name: Arterial Access Site ManagementDefinition: A record of the method used to achieve haemostasis at the site of arterial access.Format: CharactersField length: 3Codes and values: Code Value Sub Codes Sub Values 01 Manual pressure 02 Invasive A Angioseal B Vasoseal C Perclose D Starclose Z Other 03 External A Duett B Radistop C TR Band D Femstop Z Other 04 Direct suture Open repair of arteriotomy 98 Other UnlistedRelated Data Item(s): Anatomical Site.Recording Guidance: IT systems should allow for multiple recordings.4.27 Heart Valve(s)Definition: A record of the type of Heart Valve(s).Format: CharactersCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 42Consultation Document v1.0
  43. 43. Field Length: 2Codes and Values: Code Value 01 Aortic 02 Mitral 03 Tricuspid 04 Pulmonary 99 Not KnownRecording Guidance: IT systems should allow for multiple recordings.This may be linked to the specific manufacturer/device code/Serial Number.4.28 Intra-aortic balloon pump (IABP) UsedDefinition: A record of whether an intra-aortic balloon pump was used.Format: CharactersField length: 2Codes and values: Code Value 00 No 01 Yes 99 Not knownRelated Data Item(s): Intra-aortic balloon pump (IABP) - Reason used, Operative Stage.4.29 Left Main Stem ProtectedDefinition: A record of whether the left main stem was protected.Format: CharactersField length: 2Codes and values: Code Value 00 No 01 Yes 99 Not knownRelated data item(s): PCI (Percutaneous Coronary Intervention) Adjunctive Device(s).4.30 Myocardial Protection - Predominant MethodCommon Name: Predominant Method of Myocardial Protection.Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 43Consultation Document v1.0
  44. 44. Definition: The predominant method of myocardial preservation during the procedure.Format: CharactersField length: 2Codes and values: Code Value 01 Non-cardioplegic 02 CardioplegiaRelated data item(s): Cardioplegia Infusion, Cardioplegia Solution, Cardioplegia Temperature.4.31 Nature of Cardiac Diagnostic ProcedureDefinition: The nature of the Cardiac diagnostic procedure.Format: CharactersField length: 2Codes and values: Code Value 01 Coronary Angiography 02 Left ventricular Angiography 03 Graft Angiography 04 Aortogram 05 Right Heart Catheterisation 06 Measurement of Arterial Venous Oxygen Concentration 98 Other 99 Not KnownRelated Data Item(s): Anatomical Site, Nature of PCI (Percutaneous Coronary Intervention)Procedure.4.32 Nature of PCI (Percutaneous Coronary Intervention) ProcedureDefinition: The nature of the PCI (Percutaneous Coronary Intervention) Procedure.Format: CharactersField length: 3Codes and values: Code Value Sub Code Sub Value 01 Elective – Chronic Stable Angina 02 PCI for Acute Coronary Syndrome /Non ST Elevation MI 03 PCI for STEMI A Primary B RescueCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 44Consultation Document v1.0
  45. 45. C Re-Infarction D Post-infarction 04 Hybrid 98 Other 99 Not KnownRelated Data Item(s): Indication for PCI (Percutaneous Coronary Intervention).4.33 Non Cardioplegic Myocardial Protection MethodDefinition: The predominant method of Non Cardioplegic Myocardial preservation used.Format: CharactersField length: 2Codes and values: Code Value 01 Aortic Cross Clamping with fibrillation 02 Fibrillation with perfusion 03 Cross clamp with direct coronary perfusion 04 Cross clamp and beating heart 05 Beating heart without cross clamp 96 Not applicable 99 Not KnownRelated data item(s): Aortic Clamp Used, Aortic Clamp Type, Dates and Times of TheatreProcesses and Operative Procedures.4.34 PCI (Percutaneous Coronary Intervention) Adjunctive Device(s)Definition: A record of the device used during PCI (Percutaneous Coronary Intervention).Format: CharactersField length: 3Codes and values: Code Value Sub Code Sub Value Explanatory Notes 01 Angioscope 02 Thrombosuction Catheter A Diver B Export C Pronto D Rescue Rescue Device E X-Sizer Thrombectomy Device F Percusurge G Angiojet Possis Angiojet H Acolysis Z Other 03 Cutting Balloon 04 Directional Atherectomy 05 Distal Embolic Protection A Filter Wire B SpiderCardiac Surgery & Percutaneous Cardiac Interventions Data Standards 45Consultation Document v1.0
  46. 46. C Emboshield D Cardioshield E Angioguard Z Other 06 Proximal Embolic A Proxis Protection Z Other 07 Flow Wire 08 Brachytherapy A Guidant Galileo B Novoste Betacath Z Other 09 Intracoronary Drug Other than via stent Delivery Device 10 Intramycardial Injection 11 IVUS Intravascular ultrasound 12 Laser Angioplasty Device 13 OCT Optical coherence tomography 14 Pressure Wire 15 Rotational Atherectomy 16 Tornus Catheter 99 Other UnlistedRelated data item(s): Cardiac Procedure Type, Date and time of First PCI Device, InterventionSite, Procedure Status, Stenosis Diameter, Valve Type.Recording Guidance: IT Systems should allow for multiple recordings.4.35 Proximal Vascular AnastomosesDefinition: The site of the proximal connection of the conduit.Format: CharactersField length: 2Codes and values: Code Value Explanatory Note 01 Aorta 02 Left Internal Mammary Artery (LIMA) 03 Right Internal Mammary Artery (RIMA) 04 Saphenous Vein 96 Not Applicable No Proximal Anastomosis e.g. Pedicle Mammary Graft 98 Other 99 Not KnownRelated Data Item(s): Cardiac Incision Type, Cardiac Procedure Type, Coronary ArteryFindings, Conduit Anastamotic Device, Graft Conduit, Vascular Anastomsois Type.Recording Guidance: IT systems should allow for multiple recordings.Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 46Consultation Document v1.0
  47. 47. 4.36 Renal Replacement TherapyDefinition: A record of whether the patient is receiving renal replacement therapy.Format: CharactersField length: 2Codes and values: Code Value 00 No 01 Yes 99 Not KnownRelated Data Item(s): Date, Dates and Times of Theatre Processes and OperativeProcedures, Operative Stage, Renal Replacement Therapy – Type, Stages of Chronic KidneyDisease.4.37 Renal Replacement Therapy – TypeDefinition: A record of the type of renal replacement therapy.Format: CharactersField length: 3Codes and values: Code Value Sub Sub Value Code 01 Haemodialysis 02 Haemofiltration A Venovenous B Arteriovenous 03 Haemodiafiltration 04 Peritoneal dialysis A Continuous Ambulatory Peritoneal dialysis (CAPD) B Automated Peritoneal Dialysis (APD) 05 Renal transplantation 99 Not KnownRelated Data Item(s): Renal Replacement Therapy.4.38 Simultaneous ProcedureDefinition: A record of whether another procedure was carried out at the same time as theplanned procedure.Format: CharactersField length: 2Codes and values:Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 47Consultation Document v1.0
  48. 48. Code Value 00 No 01 Yes 99 Not KnownRelated Data Item: Cardiac Procedure Type, Thoracic and Vascular Procedures.4.39 Stent ImplantedDefinition: Type of implanted stent.Format: CharactersField length: 2Codes and values: Code Value 01 Bare Metal Stent 02 Drug Eluting Stent 03 Biodegradable Stent 98 Other 99 Not KnownRelated data item(s): Anatomical Site, Medication and Device name.Recording Guidance: IT systems should allow for multiple recordings.This may be linked to the specific manufacturer/device code.4.40 Thoracic and Vascular ProcedureDefinition: The type of thoracic or vascular procedure used to treat the patientFormat: CharactersField length: 2Codes and values: Code Value 01 Aortic 02 Peripheral Vascular 03 Carotid Endarterectomy 98 Other 99 Not KnownRelated Data Item(s): Cardiac Procedure Type, Simultaneous Procedure.4.41 Valve TypeDefinition: The type of valve(s).Cardiac Surgery & Percutaneous Cardiac Interventions Data Standards 48Consultation Document v1.0

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