STS 2.73 : New On-Bypass Parameters

The Great Migration to v 2.73 : 

(New STS Fields)

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The following post  describes the new fields that are identified as new data collection points in the  STS v. 2.73 Adult Cardiac Database.

(Customized PowerPoint Template for Perfusion STS Data Collection)

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Customized STS Form (for Perfusion)

Overall assessment:

Points of emphasis in this section is a broader view of the perioperative environment.  Calcification of the aorta and it’s impact on the surgery is stressed.

From a Quality point of view, post CPB assessment of valvular function is now a requirement (or at least highly recommended).  This should have little or no impact on the procedural side of things (represents no additional cost or effort) as most cardiac anesthesiologists do this as a routine part of their practice.

It just needs to be documented.

A few additional clinical points are captured and elaborated on (retrograde cerebral perfusion, cardioplegia, core temp and hemodilution).

These represent quality points and in my opinion are areas that I was surprised to see omitted in earlier STS versions.

Again, this represents a few additional areas of documentation- but represents no additional cost or impact to the patient.

New On-Bypass Parameters

LwstTemp

Record the patient’s lowest core temperature during the procedure in degrees centigrade.

LwstHct

Enter the lowest Hematocrit recorded during procedure.

CPerfUtil

Indicate whether circulatory arrest with cerebral perfusion was performed.

Selective cerebral perfusion is a technique that involves providing blood flow and metabolic support to the brain while the blood flow to the rest of the body is stopped during circulatory arrest. This approach is commonly used during complex surgery that requires circulatory arrest. It offers more protection for the brain and minimizes the risk of stroke and other serious complications.

CPerfTime

Indicate the total number of minutes cerebral perfusion was performed. This would include antegrade and/or retrograde cerebral perfusion strategies.

If more than one period of cerebral perfusion was used, add the times for the total cerebral perfusion time.

CPerfTyp

Indicate type of cerebral perfusion utilized.

• antegrade,
• retrograd
• both antegrade and retrograde.

CplegiaType

Indicate the type of cardioplegia used.

• Blood
• Crystalloid
• Both
• Other

ConCalc

Indicate whether concentric calcification of the aorta was discovered preoperatively or intraoperatively using imaging or palpation.

The intent is to capture when and if concentric calcification is discovered. This may impact the surgeons approach to cannulation.

AsmtAscAA

Indicate whether the Ascending Aorta/Arch was evaluated during surgery using TEE or epiaortic ultrasound

The aorta can be assessed with ultrasound or echocardiography to evaluate degree of calcification.

AsmtAoDx

Indicate highest grade of disease in the ascending aorta indicated on epiaortic ultrasound or TEE.

• Normal Aorta
• Extensive intimal thickening
• Protruding Atheroma < 5 mm
• Protruding Atheroma ≥ 5 mm
• Mobile Plaques
• Not Documented

AsmtAPln

Indicate if aortic assessment changed surgical plan

This assessment can assist the surgeon with selection of optimal site for cannulation of ascending aorta or may prompt decision to select alternate arterial cannulation site or an off pump approach.

IBdCryoU

Capture the number of units of Cryoprecipitate that were transfused intraoperatively.

One bag of Cryo = one unit. The number of units is not volume dependent.

IBbFactorVII

Indicate the amount of Factor VIIa that was given intraoperatively. Units are measured in micrograms per kilogram.

If the dosage is recorded as micrograms, divide by the patient’s weight in Kg to get the units.

InOpTEE

Indicate whether intraoperative TEE was performed following procedure.

This is intended to capture TEE done in the O.R. following the procedure.

PRepAR

Indicate the highest level of aortic regurgitation found on post CPB intraop TEE.

Mild-to-Moderate should be coded as moderate; moderate to severe should be coded as severe.

• None
• Trace/trivial
• Mild
• Moderate
• Severe

PRepMR

Indicate the highest level of mitral regurgitation found on post CPB intraop TEE.

Mild-to-Moderate should be coded as moderate; moderate to severe should be coded as severe.

• None
• Trace/trivial
• Mild
• Moderate
• Severe

PRepTR

Indicate the highest level of tricuspid regurgitation found on post CPB intraop TEE.

Mild-to-Moderate should be coded as moderate; moderate to severe should be coded as severe.

• None
• Trace/trivial
• Mild
• Moderate
• Severe