Ann Thorac Surg 2000;69:S332-S342
© 2000 The Society of Thoracic Surgeons
Congenital Heart Surgery Nomenclature and Database Project: therapeutic cardiac catheter interventions
Albert P. Rocchini, MDa
a Division of Pediatric Cardiology, C.S. Mott Children’s Hospital, University of Michigan Medical Center, Ann Arbor, Michigan, USA
Address reprint requests to Dr Rocchini, Division of Pediatric Cardiology, University of Michigan Medical Center, MCHC F1310, Box 0204, Ann Arbor, MI 48109-0204
e-mail: rocchini{at}umich.edu
Presented at the International Nomenclature and Database Conferences for Pediatric Cardiac Surgery, 1998–1999.
Abstract
The extant nomenclature for therapeutic cardiac catheter interventions is reviewed for the purpose of establishing a unified reporting system. The subject was debated and reviewed by members of the STS-Congenital Heart Surgery Database Committee and representatives from the European Association for Cardiothoracic Surgery. All efforts were made to include all relevant nomenclature categories using synonyms where appropriate. A comprehensive database set is presented which is based on a hierarchical scheme. Data are entered at various levels of complexity and detail which can be determined by the clinician. These data can lay the foundation for comprehensive risk stratification analyses. A minimum database set is also presented which will allow for data sharing and would lend itself to basic interpretation of trends. Outcome tables relating diagnoses, procedures, and various risk factors are presented.
I. Background
Therapeutic cardiac catheter interventions are defined as any procedure that utilizes an intravascular catheter to treat a cardiovascular malformation. The first documented catheter intervention on a congenital cardiac lesion was reported by Rubio-Alvarez in 1953 [1]. He treated valvar pulmonary stenosis by pulling a wire mounted on the arced tip of a catheter through a stenotic pulmonary valve. Although this procedure was not repeated by others, it did mark the first attempt in the pediatric patient to use a catheter intervention to treat congenital heart disease. The balloon atrial septostomy was the first widely used application of a catheter intervention. In 1966 [2], Rashkind and Miller reported the first balloon septostomy in an infant with d-transposition of the great arteries (S,D,D). Since their report, the number of catheter based interventions has grown considerably. The modem era of pediatric interventional cardiology began in 1982, when Kan and colleagues [3] reported the first balloon valvuloplasty of a stenotic pulmonary valve.
The care of all children with congenital cardiac malformations is a collaborative effort of pediatric cardiologists and cardiac surgeons. Therapeutic cardiac catheter interventions have been incorporated into the management of patients with congenital heart disease, either being used as a nonsurgical alternate or used in collaboration with surgical procedures to improve outcome in individuals with complex and challenging forms of congenital heart disease. As with cardiac surgical procedures, therapeutic cardiac catheter interventions can be either palliative, such as the Rashkind balloon septostomy, or they can be reparative, as the pulmonary valvuloplasty [4–7].
II. Analysis: a unified therapeutic cardiac catheter interventions nomenclature system
Therapeutic cardiac catheter interventions hierarchy level 1
- Therapeutic cardiac catheter intervention
Therapeutic cardiac catheter interventions hierarchy level 1 definitions
Therapeutic cardiac catheter intervention
Any procedure that utilizes an intravascular catheter to treat a cardiovascular malformation.
Therapeutic cardiac catheter interventions hierarchy level 2
- Therapeutic cardiac catheter intervention, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab
- Therapeutic cardiac catheter intervention, Operating room
Therapeutic cardiac catheter interventions hierarchy level 2 definitions
Therapeutic cardiac catheter intervention, catheterization lab
The interventional procedure is performed in the cardiac catheterization laboratory.
Therapeutic cardiac catheter intervention, operating room
The interventional procedure is performed at the time of a cardiac surgical procedure.
Therapeutic cardiac catheter interventions hierarchy level 3
- Therapeutic cardiac catheter intervention, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon valvuloplasty
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon septostomy
- Therapeutic cardiac catheter intervention, Catheterization lab, Blade septostomy
- Therapeutic cardiac catheter intervention, Catheterization lab, Radiofrequency (RF) ablation
- Therapeutic cardiac catheter intervention, Catheterization lab, Septal occluder
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent
- Therapeutic cardiac catheter intervention, Catheterization lab, Coil
- Therapeutic cardiac catheter intervention, Catheterization lab, Other device implantation
- Therapeutic cardiac catheter intervention, Operating room, NOS
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty
- Therapeutic cardiac catheter intervention, Operating room, Aortic balloon valvuloplasty
- Therapeutic cardiac catheter intervention, Operating room, Cryoablation
- Therapeutic cardiac catheter intervention, Operating room, Ventricular septal defect (VSD) septal occluder
- Therapeutic cardiac catheter intervention, Operating room, Stent
- Therapeutic cardiac catheter intervention, Operating room, Other device implantation
Therapeutic cardiac catheter interventions hierarchy level 3 definitions
Balloon angioplasty
The use of a balloon catheter to enlarge a stenotic vessel [4].
Balloon valvuloplasty
The use of a balloon catheter to enlarge a stenotic cardiac valve [3].
Balloon septostomy
The use of a balloon catheter to create an atrial septal defect (ASD). The balloon is inflated and either actively pulled through the atrial septum, ie, Rashkind balloon septostomy [2], or is statically left in place.
Blade septostomy
The use of a Park blade septostomy catheter to create an atrial septal defect [5].
Radiofrequency ablation
The use of a catheter that can provide radiofrequency energy to ablate cardiac tissue.
Cryoablation
The use of a probe to deliver extremely cold temperatures in order to freeze cardiac tissue.
Septal occluder
The use of a catheter delivered device to close a cardiac defect. The defect can be in the atrial or ventricular septum, a large patent ductus arteriosus (PDA), or a large venous collateral channel. There are currently five devices in clinical trials. These devices are: the CardioSeal, formerly the Bard Clamshell Septal Umbrella (USCI Division, C.R. Bard, Billerica, MA); the Buttoned device (Custom Medical Devices, Amarillo, TX); the ASDOC device (Osypka Corp, Grenzach-Wyhlen, Germany); the Das-Angel Wings device (Microvena, Vadnais, MN); and the Amplatzer Septal Occluder (AGA Medical Corp, Golden Valley, MN)]. The Rashkind PDA occluder [8] and Clamshell [9] are older devices that are not currently available in the United States. The Rashkind PDA occluder is still being used in Canada and Europe.
Stent
The use of a device to provide support to maintain patency of a narrowed vascular structure. There are a number of different types of stents that are currently in use. The most commonly used stent is the balloon expandable stainless steel stent developed by Palmaz [10]. Other types of stents include the self-expanding Wallstent (Schneider, Minneapolis, MN) and the Gianturco-Rubin stent. There are also cloth covered stents that are currently in clinical trials.
Coil
The use of steel coils that can be embolized to occlude vascular structures. The most commonly used coil is the Gianturco coil (Cook, Bloomington, IN). Other coils that are in current use include: Grifka-Gianturco occlusion bag and the detachable coil device.
Other devices
The use of other devices to treat cardiovascular lesions. This category is meant for rarely used devices that are not covered by the previously described categories. Examples of these devices are: detachable balloons, gelatin sponge (Gelfoam) particles, polyvinyl alcohol (Ivalon) particles and other new devices that are in development.
Therapeutic cardiac catheter interventions hierarchy level 4
- Therapeutic cardiac catheter intervention, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Systemic artery
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Systemic vein
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary artery
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary vein
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Conduit
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon valvuloplasty, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon valvuloplasty, Aortic
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon valvuloplasty, Mitral
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon valvuloplasty, Tricuspid
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon valvuloplasty, Pulmonic
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon valvuloplasty, Conduit valve
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon septostomy
- Therapeutic cardiac catheter intervention, Catheterization lab, Blade septostomy
- Therapeutic cardiac catheter intervention, Catheterization lab, Radiofrequency ablation, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Radiofrequency ablation, Atrial
- Therapeutic cardiac catheter intervention, Catheterization lab, Radiofrequency ablation, Atrial-ventricular node
- Therapeutic cardiac catheter intervention, Catheterization lab, Radiofrequency ablation, Ventricular
- Therapeutic cardiac catheter intervention, Catheterization lab, Radiofrequency ablation, Atretic pulmonary valve
- Therapeutic cardiac catheter intervention, Catheterization lab, Septal occluder, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Septal occluder, Atrial septal defect (ASD)
- Therapeutic cardiac catheter intervention, Catheterization lab, Septal occluder, VSD
- Therapeutic cardiac catheter intervention, Catheterization lab, Septal occluder, Patent ductus arteriosus (PDA)
- Therapeutic cardiac catheter intervention, Catheterization lab, Septal occluder, Fontan fenestration
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Systemic artery
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Systemic vein
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary artery
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary vein
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Conduit
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, PDA
- Therapeutic cardiac catheter intervention, Catheterization lab, Coil, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Coil, Systemic vein
- Therapeutic cardiac catheter intervention, Catheterization lab, Coil, Pulmonary arteriovenous malformation
- Therapeutic cardiac catheter intervention, Catheterization lab, Coil, Systemic arteriovenous malformation
- Therapeutic cardiac catheter intervention, Catheterization lab, Coil, Aorta to pulmonary artery collateral
- Therapeutic cardiac catheter intervention, Catheterization lab, Coil, PDA
- Therapeutic cardiac catheter intervention, Catheterization lab, Coil, ASD
- Therapeutic cardiac catheter intervention, Catheterization lab, Coil, Fontan fenestration
- Therapeutic cardiac catheter intervention, Catheterization lab, Other device implantation
- Therapeutic cardiac catheter intervention, Operating room, NOS
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, NOS
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Systemic artery
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Systemic vein
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary artery
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary vein
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Conduit
- Therapeutic cardiac catheter intervention, Operating room, Aortic balloon valvuloplasty
- Therapeutic cardiac catheter intervention, Operating room, Cryoablation, NOS
- Therapeutic cardiac catheter intervention, Operating room, Cryoablation, Atrial
- Therapeutic cardiac catheter intervention, Operating room, Cryoablation, Atrioventricular (AV) node
- Therapeutic cardiac catheter intervention, Operating room, Cryoablation, Ventricular
- Therapeutic cardiac catheter intervention, Operating room, VSD septal occluder
- Therapeutic cardiac catheter intervention, Operating room, Stent, NOS
- Therapeutic cardiac catheter intervention, Operating room, Stent, Systemic artery
- Therapeutic cardiac catheter intervention, Operating room, Stent, Systemic vein
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary artery
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary vein
- Therapeutic cardiac catheter intervention, Operating room, Stent, Conduit
- Therapeutic cardiac catheter intervention, Operating room, Other device implantation
Therapeutic cardiac catheter interventions hierarchy level 4 definitions
Conduit
A tube that is used to connect one cardiac structure with another, usually a ventricular chamber to a great artery. The conduit may or may not contain a valve. The conduit can be made of prosthetic material, xenograft tissue or homograft tissue.
Pulmonary valve
The semilunar valve that connects to the pulmonary trunk. This includes the neopulmonary valve in individuals following the arterial switch procedure [6].
Aortic valve
The semilunar valve that connects to the aorta. This includes the truncal valve in individuals with truncus arteriosis and the neoaortic valve in individuals following the Norwood procedure or following the arterial switch procedure.
Aorta to pulmonary artery collateral
An artery, other than the ductus arteriosus, that connects the aorta to a pulmonary artery.
Ablation, atrial
The application of radiofrequency energy (radiofrequency ablation) or extremely cold temperature (cryoablation) to atrial tissue. This procedure is used in individuals with the following types of arrhythmias: atrial ectopic tachycardia, Wolff-Parkinson-White syndrome, and atrial flutter [11].
Ablation, AV nodal
The application of radiofrequency energy (radiofrequency ablation) or extremely cold temperature (cryoablation) to tissue in the AV node or perinodal area. This procedure is used in individuals with the following types of arrhythmias: AV node reentry tachycardia, junctional ectopic tachycardia, and when it is desired to create complete heart block [11].
Ablation, ventricular
The application of radiofrequency energy (radiofrequency ablation) or extremely cold temperature (cryoablation) to ventricular tissue. This procedure is used in individuals with ventricular tachyarrhythmias [11].
Ablation, atretic pulmonary valve
The use of radiofrequency energy to cross an atretic pulmonary valve. Included in this category would also be individuals in whom a guidewire, special transseptal needle or laser guidewire wire was used to cross the valve [12].
Therapeutic cardiac catheter interventions hierarchy level 5
- Therapeutic cardiac catheter intervention, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Systemic artery, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Systemic artery, Thoracic aortic coarctation
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Systemic artery, Abdominal aortic coarctation
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Systemic artery, Other systemic artery
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Systemic vein, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Systemic vein, Superior vena cava
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Systemic vein, Inferior vena cava
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Systemic vein, Other systemic vein
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary artery, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary artery, Main (Trunk)
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary artery, Branch, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary artery, Branch, Central (Within the hilar bifurcation), NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary artery, Branch, Central (Within the hilar bifurcation), Left
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary artery, Branch, Central (Within the hilar bifurcation), Right
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary artery, Branch, Central (Within the hilar bifurcation), Left and right
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary artery, Branch, Central (Within the hilar bifurcation), Left and right including PA carinal stenosis
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary artery, Branch, Peripheral (At or beyond the hilar bifurcation), NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary artery, Branch, Peripheral (At or beyond the hilar bifurcation), Left
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary artery, Branch, Peripheral (At or beyond the hilar bifurcation), Right
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary artery, Branch, Peripheral (At or beyond the hilar bifurcation), Left and right
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary vein, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary vein, Left (LPV) NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary vein, Left Upper (LUPV)
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary vein, Left Lower (LLPV)
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary vein, Right (RPV) NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary vein, Right Upper (RUPV)
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary vein, Right Lower (RLPV)
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Pulmonary vein, Other
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon angioplasty, Conduit
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon valvuloplasty, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon valvuloplasty, Aortic
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon valvuloplasty, Mitral
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon valvuloplasty, Tricuspid
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon valvuloplasty, Pulmonic
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon valvuloplasty, Conduit valve
- Therapeutic cardiac catheter intervention, Catheterization lab, Balloon septostomy
- Therapeutic cardiac catheter intervention, Catheterization lab, Blade septostomy
- Therapeutic cardiac catheter intervention, Catheterization lab, Radiofrequency ablation, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Radiofrequency ablation, Atrial
- Therapeutic cardiac catheter intervention, Catheterization lab, Radiofrequency ablation, AV node
- Therapeutic cardiac catheter intervention, Catheterization lab, Radiofrequency ablation, Ventricular
- Therapeutic cardiac catheter intervention, Catheterization lab, Radiofrequency ablation, Atretic pulmonary valve
- Therapeutic cardiac catheter intervention, Catheterization lab, Septal occluder, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Septal occluder, ASD
- Therapeutic cardiac catheter intervention, Catheterization lab, Septal occluder, VSD
- Therapeutic cardiac catheter intervention, Catheterization lab, Septal occluder, PDA
- Therapeutic cardiac catheter intervention, Catheterization lab, Septal occluder, Fontan fenestration
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Systemic artery, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Systemic artery, Thoracic aortic coarctation
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Systemic artery, Abdominal aortic coarctation
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Systemic artery, Other systemic artery
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Systemic vein, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Systemic vein, Superior vena cava
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Systemic vein, Inferior vena cava
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Systemic vein, Other systemic vein
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary artery, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary artery, Main (Trunk)
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary artery, Branch, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary artery, Branch, Central (Within the hilar bifurcation), NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary artery, Branch, Central (Within the hilar bifurcation), Left
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary artery, Branch, Central (Within the hilar bifurcation), Right
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary artery, Branch, Central (Within the hilar bifurcation), Left and right
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary artery, Branch, Central (Within the hilar bifurcation), Left and right including PA carinal stenosis
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary artery, Branch, Peripheral (At or beyond the hilar bifurcation), NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary artery, Branch, Peripheral (At or beyond the hilar bifurcation), Left
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary artery, Branch, Peripheral (At or beyond the hilar bifurcation), Right
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary artery, Branch, Peripheral (At or beyond the hilar bifurcation), Left and right
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary vein, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary vein, LPV NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary vein, LUPV
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary vein, LLPV
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary vein, RPV NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary vein, RUPV
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary vein, RLPV
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Pulmonary vein, Other
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, Conduit
- Therapeutic cardiac catheter intervention, Catheterization lab, Stent, PDA
- Therapeutic cardiac catheter intervention, Catheterization lab, Coil, NOS
- Therapeutic cardiac catheter intervention, Catheterization lab, Coil, Systemic vein
- Therapeutic cardiac catheter intervention, Catheterization lab, Coil, Pulmonary arteriovenous malformation
- Therapeutic cardiac catheter intervention, Catheterization lab, Coil, Systemic arteriovenous malformation
- Therapeutic cardiac catheter intervention, Catheterization lab, Coil, Aorta to pulmonary artery collateral
- Therapeutic cardiac catheter intervention, Catheterization lab, Coil, PDA
- Therapeutic cardiac catheter intervention, Catheterization lab, Coil, ASD
- Therapeutic cardiac catheter intervention, Catheterization lab, Coil, Fontan fenestration
- Therapeutic cardiac catheter intervention, Catheterization lab, Other device implantation
- Therapeutic cardiac catheter intervention, Operating room, NOS
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, NOS
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Systemic artery, NOS
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Systemic artery, Thoracic aortic coarctation
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Systemic artery, Abdominal aortic coarctation
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Systemic artery, Other systemic artery
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Systemic vein, NOS
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Systemic vein, Superior vena cava
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Systemic vein, Inferior vena cava
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Systemic vein, Other systemic vein
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary artery, NOS
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary artery, Main (Trunk)
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary artery, Branch, NOS
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary artery, Branch, Central (Within the hilar bifurcation), NOS
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary artery, Branch, Central (Within the hilar bifurcation), Left
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary artery, Branch, Central (Within the hilar bifurcation), Right
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary artery, Branch, Central (Within the hilar bifurcation), Left and right
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary artery, Branch, Central (Within the hilar bifurcation), Left and right including PA carinal stenosis
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary artery, Branch, Peripheral (At or beyond the hilar bifurcation), NOS
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary artery, Branch, Peripheral (At or beyond the hilar bifurcation), Left
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary artery, Branch, Peripheral (At or beyond the hilar bifurcation), Right
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary artery, Branch, Peripheral (At or beyond the hilar bifurcation), Left and right
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary vein, NOS
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary vein, LPV NOS
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary vein, LUPV
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary vein, LLPV
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary vein, RPV NOS
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary vein, RUPV
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary vein, RLPV
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Pulmonary vein, Other
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Conduit
- Therapeutic cardiac catheter intervention, Operating room, Balloon angioplasty, Aortic balloon valvuloplasty
- Therapeutic cardiac catheter intervention, Operating room, Cryoablation, NOS
- Therapeutic cardiac catheter intervention, Operating room, Cryoablation, Atrial
- Therapeutic cardiac catheter intervention, Operating room, Cryoablation, AV Node
- Therapeutic cardiac catheter intervention, Operating room, Cryoablation, Ventricular
- Therapeutic cardiac catheter intervention, Operating room, VSD septal occluder
- Therapeutic cardiac catheter intervention, Operating room, Stent, NOS
- Therapeutic cardiac catheter intervention, Operating room, Stent, Systemic artery, NOS
- Therapeutic cardiac catheter intervention, Operating room, Stent, Systemic artery, Thoracic aortic coarctation
- Therapeutic cardiac catheter intervention, Operating room, Stent, Systemic artery, Abdominal aortic coarctation
- Therapeutic cardiac catheter intervention, Operating room, Stent, Systemic artery, Other systemic artery
- Therapeutic cardiac catheter intervention, Operating room, Stent, Systemic vein, NOS
- Therapeutic cardiac catheter intervention, Operating room, Stent, Systemic vein, Superior vena cava
- Therapeutic cardiac catheter intervention, Operating room, Stent, Systemic vein, Inferior vena cava
- Therapeutic cardiac catheter intervention, Operating room, Stent, Systemic vein, Other systemic vein
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary artery, NOS
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary artery, Main (Trunk)
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary artery, Branch, NOS
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary artery, Branch, Central (Within the hilar bifurcation), NOS
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary artery, Branch, Central (Within the hilar bifurcation), Left
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary artery, Branch, Central (Within the hilar bifurcation), Right
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary artery, Branch, Central (Within the hilar bifurcation), Left and right
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary artery, Branch, Central (Within the hilar bifurcation), Left and right including pulmonary artery carinal stenosis
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary artery, Branch, Peripheral (At or beyond the hilar bifurcation), NOS
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary artery, Branch, Peripheral (At or beyond the hilar bifurcation), Left
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary artery, Branch, Peripheral (At or beyond the hilar bifurcation), Right
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary artery, Branch, Peripheral (At or beyond the hilar bifurcation), Left and right
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary vein, NOS
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary vein, LPV NOS
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary vein, LUPV
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary vein, LLPV
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary vein, RPV NOS
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary vein, RUPV
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary vein, RLPV
- Therapeutic cardiac catheter intervention, Operating room, Stent, Pulmonary vein, Other
- Therapeutic cardiac catheter intervention, Operating room, Stent, Conduit
- Therapeutic cardiac catheter intervention, Operating room, Other device implantation
Therapeutic cardiac catheter interventions hierarchy level 5 definitions
Thoracic aortic coarctation
A narrowing of the aortic lumen that is localized to the thoracic aorta. This category includes a discrete aortic narrowing, tubular aortic hypoplasia, both native and recurrent coarctation and coarctation after Norwood repair.
Abdominal aortic coarctation
A narrowing of the aortic lumen that is localized in the midthoracoabdominal aorta. The coarctation can be an isolated finding or include narrowing of other abdominal aortic vessels. This category also includes individuals with Takayasu arteritis and stenotic aortoarteriopathy [13].
Other systemic artery
Any systemic arterial narrowing other than coarctation of the thoracic or abdominal aorta.
Other systemic vein
Any systemic venous structure other than the superior or inferior vena cava.
Pulmonary artery, main (trunk)
Includes the main pulmonary trunk prior to its bifurcation.
Pulmonary artery, branch, central
Includes all of the pulmonary arterial tree from the main pulmonary bifurcation to within the hilar bifurcation or trifurcation.
Pulmonary artery, branch, peripheral
Includes all of the pulmonary arterial tree from the hilar bifurcation and beyond.
Additional comments
A separate module of the database must permit coding of the type and manufacture of interventional catheters and devices that are used in the procedure.
III. Procedure short lists
- Procedure Short List
- ASD repair, Device
- VSD repair, Device
- PDA closure, Device
- ASD creation, Balloon septostomy (BAS) (Rashkind)
- ASD creation, Blade septostomy
- Balloon dilation
- Stent placement
- Device closure
- RF ablation
- Coil embolization
IV. Potential related risk factors
In addition to the common data fields utilized in the minimal data set and comprehensive data set applicable to all lesions, specific data fields to be tracked for therapeutic cardiac catheter interventions include the following data fields.
- Neonate, less than 28 days of age [10]
- Individuals within 14 days of cardiac operation
- Individual on extracorporeal membrane oxygenation [12]
Specific complications associated with therapeutic cardiac catheter interventions to be studied include:
- Valvular regurgitation
- Vessel rupture
- Ventricular perforation
- Vessel dissection
- Cardiac arrest
- Death
- Need for mechanical circulatory support (extracorporeal membrane oxygenation or aortic balloon pump)
- Neurologic
- Infectious
- Need for emergent operation
- Complete heart block
- Life threatening arrhythmias (hemodynamically significant ventricular tachycardia and atrial tachycardias requiring cardioversion)
- Aortic aneurysm
- Device embolization
- Hemorrhage requiring transfusion
- Obstruction of a femoral vessel (either venous or arterial)
- Residual shunt Qp/Qs
1.5:1 Qp/Qs < 1.5:1
A separate module of the database must permit assessment of success of the interventional procedure. Success can be quantified by the following:
- For device closure of PDA, ASD, VSD, aorta-to-pulmonary collaterals, and venous channels, the magnitude of residual shunt can be calculated (Qp/Qs) or the qualitative amount of residual angiographic shunt can be estimated (using an ordinal scale ranging from 0 to 4).
- For radiofrequency ablations or surgical cryoablation, the success of the procedure can be quantified by the presence or absence of inducible arrhythmia.
- For angioplasty and stent procedures, the success of the procedure can be quantified by the change in pressure gradient across the dilated area, the change in dimension of the dilated area, and in the case of angioplasty or stent placement in a branch pulmonary artery, the change in lung perfusion can be measured utilizing radionucleotide lung perfusion scans.
- For valvuloplasty procedures, the success of the procedure can be quantified by the change in pressure gradient (simultaneously measured or by direct pullback) across the stenotic valve, or by the Doppler estimated change in pressure gradient across the dilated valve.
V. Database studies and outcome analysis
Outcome tables
General therapeutic cardiac catheter intervention type (by year)
This table will show the number and percentage of each major therapeutic cardiac catheter intervention (according to hierarchy 3) for each year. (If no specific type of therapeutic cardiac catheter intervention is given, the intervention will be classified as Therapeutic cardiac catheter intervention, NOS.) (All tables below will break down the data for each given year of data collection and also will provide the total data of the cumulative experience.)
Specific therapeutic cardiac catheter intervention (by year)
This table will show the number and percentage of each specific type of therapeutic cardiac catheter intervention (according to hierarchy 4) for each year.
Age (years) of each major therapeutic cardiac catheter intervention (by year)
This table will show the distribution of age at intervention for each major type of intervention for each year.
Fluoroscopy time for each major therapeutic cardiac catheter intervention (by year)
This table will show the distribution of fluoroscopy time used for each major type of intervention for each year.
General anesthesia for each major therapeutic cardiac catheter intervention (by year)
This table will show the number and percentage of individuals who required general anesthesia for each major type of intervention for each year.
General anesthesia for infants less than 28 days for each major therapeutic cardiac catheter intervention (by year)
For infants less than 28 days, this table will show the number and percentage who required general anesthesia for each major type of intervention for each year.
General anesthesia for infants greater than 28 days less than 1 year for each major therapeutic cardiac catheter intervention (by year)
For infants greater than 28 days and less than 1 year, this table will show the number and percentage who required general anesthesia for each major type of intervention for each year.
General anesthesia for children greater than 1 year for each major therapeutic cardiac catheter intervention (by year)
For children greater than 1 year this table will show the number and percentage who required general anesthesia for each major type of intervention for each year.
For each major therapeutic cardiac catheter intervention complication incidence (including death at time of procedure) (by year)
This table will show the number and percentage of procedure related deaths and complications (both transient and permanent, for each major organ system [cardiac, pulmonary, renal, infectious, neurologic]) for each major type of intervention for each year.
For each major therapeutic cardiac catheter intervention complication incidence (including death at time of procedure) for infants less than 28 days of age (by year)
For infants less than 28 days of age, this table will show the number and percentage of procedure related deaths and complications (both transient and permanent, for each major organ system, including cardiac, pulmonary, renal infectious, and neurologic) for each major type of intervention for each year.
For each major therapeutic cardiac catheter intervention complication incidence (including death at time of procedure) for infants greater than 28 days and less than 1 year of age (by year)
For infants greater than 28 days and less than 1 year of age, this table will show the number and percentage of procedure related deaths and complications (both transient and permanent, for each major organ system, including cardiac, pulmonary, renal infectious, and neurologic) for each major type of intervention for each year.
For each major therapeutic cardiac catheter intervention complication incidence (including death at time of procedure) in children greater than 1 year of age (by year)
For children greater than 1 year of age, this table will show the number and percentage of procedure related deaths and complications (both transient and permanent, for each major organ system, including cardiac, pulmonary, renal, infectious, and neurologic) for each major type of intervention for each year.
Total length of hospital stay (days) (by year)
This table will show the total length of hospital stay for each major type or intervention procedure for each year.
Total length of hospital stay (days) by patient age (by year)
This table will show the length of hospital stay for each major type of intervention for each year, comparing patients less than 28 days, greater than 28 days and less than 1 year, and greater than 1 year of age.
Total length of hospital stay (days) (by year) excluding individuals having cardiac operation within 2 weeks prior to interventional procedure
This table will show the total length of hospital stay for each major type or intervention procedure, for each year, in all individuals who did not have cardiac operation within 2 weeks before the catheter intervention was performed.
Total length of hospital stay (days) by patient age (by year) excluding individuals having cardiac operation within 2 weeks prior to interventional procedure or cardiac surgery (not due to an intervention complication) after intervention, during the same hospitalization
This table will show the length of hospital stay for each major type of intervention, for each year, comparing patients less than 28 days, greater than 28 days and less than 1 year, and greater than 1 year of age, in all individuals who did not have cardiac operation within 2 weeks before the catheter intervention was performed or cardiac surgery (not related to an intervention complication) after the intervention during the same hospitalization.
Success of each major type of therapeutic cardiac catheter intervention (by year)
This table will show the number and percentage of successful interventions for each major intervention type for each year. (Success will be quantified individually for each specific interventional procedure).
Success of each major type of therapeutic cardiac catheter intervention by patient age (by year)
This table will show the number and percentage of successful interventions for each major intervention type for each year, comparing patients less than 28 days, greater than 28 days and less than 1 year, and greater than 1 year of age. (Success will be quantified individually for each specific interventional procedure).
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