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Report from The International Society for Nomenclature of Paediatric and Congenital Heart Disease: cardiovascular catheterisation for congenital and paediatric cardiac disease (Part 2 – Nomenclature of complications associated with interventional cardiology)

Published online by Cambridge University Press:  11 February 2011

Lisa Bergersen
Affiliation:
Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts, United States of America
Jorge Manuel Giroud
Affiliation:
The Congenital Heart Institute of Florida (CHIF), Division of Pediatric Cardiology, All Children's Hospital and Children's Hospital of Tampa, University of South Florida College of Medicine, Pediatric Cardiology Associates/Pediatrix Medical Group, Saint Petersburg and Tampa, Florida, United States of America
Jeffrey Phillip Jacobs
Affiliation:
The Congenital Heart Institute of Florida (CHIF), Division of Thoracic and Cardiovascular Surgery, All Children's Hospital and Children's Hospital of Tampa, University of South Florida College of Medicine, Cardiac Surgical Associates of Florida (CSAoF), Saint Petersburg and Tampa, Florida, United States of America
Rodney Cyril George Franklin
Affiliation:
Paediatric Cardiology Directorate, Royal Brompton & Harefield NHS Trust, London, United Kingdom
Marie Josée Béland
Affiliation:
Division of Pediatric Cardiology, The Montreal Children's Hospital of the McGill University Health Centre, Montréal, Quebec, Canada
Otto Nils Krogmann
Affiliation:
Kinik für Kinderkardiologie (Clinic for Pediatric Cardiology) – Angeborene Herzfehler, Heart Center Duisburg, Duisburg, Germany
Vera Demarchi Aiello
Affiliation:
Laboratory of Pathology, Heart Institute (InCor), Sao Paulo University School of Medicine, Sao Paulo, Brazil
Steven D. Colan
Affiliation:
Department of Cardiology, Children's Hospital, Boston, Massachusetts, United States of America
Martin J. Elliott
Affiliation:
Cardiac Unit, Great Ormond Street Hospital for Children, London, United Kingdom
J. William Gaynor
Affiliation:
Cardiac Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
Hiromi Kurosawa
Affiliation:
Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
Bohdan Maruszewski
Affiliation:
Department of Cardiothoracic Surgery, The Children's Memorial Health Institute, Warsaw, Poland
Giovanni Stellin
Affiliation:
Pediatric Cardiac Surgery Unit, University of Padova Medical School, Padova, Italy
Christo I. Tchervenkov
Affiliation:
Division of Pediatric Cardiovascular Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montréal, Quebec, Canada
Henry Lane Walters III
Affiliation:
Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, United States of America
Paul Weinberg
Affiliation:
Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, Pennsylvania, United States of America
Allen Dale Everett*
Affiliation:
Pediatric Cardiology, Johns Hopkins University, Baltimore, Maryland, United States of America
*
Correspondence to: Dr A.D. Everett, Pediatric Cardiology, Johns Hopkins University, Baltimore, Maryland, United States of America. Tel: (410) 502-0699; Fax: (410) 955-0897; E-mail: aeveret3@jhmi.edu
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Abstract

Interventional cardiology for paediatric and congenital cardiac disease is a relatively young and rapidly evolving field. As the profession begins to establish multi-institutional databases, a universal system of nomenclature is necessary for the field of interventional cardiology for paediatric and congenital cardiac disease. The purpose of this paper is to present the results of the efforts of The International Society for Nomenclature of Paediatric and Congenital Heart Disease to establish a system of nomenclature for cardiovascular catheterisation for congenital and paediatric cardiac disease, focusing both on procedural nomenclature and the nomenclature of complications associated with interventional cardiology. This system of nomenclature for cardiovascular catheterisation for congenital and paediatric cardiac disease is a component of The International Paediatric and Congenital Cardiac Code. This manuscript is the second part of the two-part series. Part 1 covered the procedural nomenclature associated with interventional cardiology as treatment for paediatric and congenital cardiac disease. Part 2 will cover the nomenclature of complications associated with interventional cardiology as treatment for paediatric and congenital cardiac disease.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2011

Interventional cardiology for paediatric and congenital cardiac disease is a relatively young and rapidly evolving field. A common system of nomenclature for interventional cardiology is imperative, particularly as we go beyond evaluating our individual practice to establishing multi-institutional and multi-national databases.Reference Jacobs1Reference Jenkins, Beekman and Bergersen5 The purpose of this two-part series of manuscripts is to present the version of nomenclature of The International Paediatric and Congenital Cardiac Code updated to include a new system of nomenclature for cardiovascular catheterisation for congenital and paediatric cardiac disease, focusing both on procedural nomenclature and the nomenclature of complications associated with interventional cardiology.

This manuscript is the second part of a two-part series. Part 1 covered the procedural nomenclature associated with interventional cardiology as treatment for paediatric and congenital cardiac disease.Reference Bergersen, Everett and Giroud6 Part 2 will cover the nomenclature of complications associated with interventional cardiology as treatment for paediatric and congenital cardiac disease. These two “companion” papers are designed to be read together. Specific complications related to transcatheter procedures involving arrhythmias, such as ablation and procedures involving pacemakers, are not included in this paper; these complications related to transcatheter procedures involving arrhythmias have already been discussed somewhat in prior publications from our groupReference Jacobs1 and likely will be addressed further in additional publications from our group. In order to place these papers in perspective, Part 1 begins with a brief summary of the history and current status of The International Paediatric and Congenital Cardiac Code and the IMPACT Registry™ (IMproving Pediatric and Adult Congenital Treatment) of the National Cardiovascular Data Registry®.

The creation of a comprehensive listing of complications associated with interventional cardiology as treatment for paediatric and congenital cardiac disease is crucial because of the increasing interest in the benchmarking and establishment of outcomes for these treatments. A critical component in the determination of outcomes after cardiac catheterisation is a comprehensive list of complications to serve as the basis for establishment of benchmarks related to the safety of patients. Using the process developed by The International Society for Nomenclature of Paediatric and Congenital Heart Disease during the creation of The International Paediatric and Congenital Cardiac Code, we describe the development of a comprehensive effort to develop a list of complications for the procedures associated with congenital cardiac catheterisation.

Methodology of the development of the list of complications of The International Paediatric and Congenital Cardiac Code

The basis for this long list of complications originated with the use of the structure and crossmap of terms developed by The International Society for Nomenclature of Paediatric and Congenital Heart Disease during the creation of The International Paediatric and Congenital Cardiac Code.Reference Franklin, Jacobs, Tchervenkov and Béland7Reference Béland, Franklin and Jacobs12 The list was further refined by taking advantage of two large ongoing studies of outcomes after paediatric and congenital cardiac catheterisation in the United States of AmericaReference Jenkins, Beekman and Bergersen5: The Congenital Cardiac Catheterization Outcomes Project (C3PO)Reference Bergersen, Marshall and Gauvreau13 and the Mid-Atlantic Group of Interventional Cardiology (MAGIC).Reference Everett, Ringel and Rhodes14 This process allowed for the addition of further codes drawn from the experience of multiple cardiologists. In total, 329 codes of complications associated with congenital cardiac catheterisation were developed along with 166 codes for associated modifiers. The list of codes was particularly enhanced by incorporating the structure for modifiers used in the Congenital Cardiac Catheterization Outcomes Project for the following five variables (the first three of these variables are related to “process” and the last two of these variables are related to “outcome”):

  • the relationship of the complication to a specific component of the procedure (such as related to the administration of sedation: “Sedation related”, or related to the dilation component of the procedure: “Dilation related”, etc.),

  • the timing of the complication (in or out of the catheterisation laboratory, before access, after removal of sheaths, etc.),

  • the preventability of the complication,

  • the outcome of the complication, and

  • the severity of the complication (none to catastrophic).

Results

Using the International Paediatric and Congenital Cardiac Code and the hierarchical structure of the International Congenital Heart Surgery Nomenclature and Database Project of The European Association for Cardio-Thoracic Surgery and The Society of Thoracic Surgeons, codes for complications are broken down into main categories (Table 1) and then expanded in further detail beneath each branch level. For example, if tricuspid insufficiency is present after transcatheter closure of an atrial septal defect, the term “Trauma” is chosen from the level 2 of the hierarchy (Table 1), followed by the more detailed anatomic descriptor, “Heart valve”, and the specific complication “Tricuspid valve insufficiency, New onset”. Fully coded, this complication appears as:

“Cardiac catheterization, Complication, Trauma, Heart valve, Tricuspid valve insufficiency, New onset”.

Table 1 Complication code hierarchy main categories (level 2).

This complication equates to the following numerical codes and mapped terms in the version of The International Paediatric and Congenital Cardiac Code derived from the European Paediatric Cardiac Code of the Association for European Paediatric Cardiology:

This example illustrates how either version of The International Paediatric and Congenital Cardiac Code can be used by individual institutions for use in comparisons of outcomes. The complete lists of codes for complications associated with cardiovascular catheterization for congenital and paediatric cardiac disease, as laid out in the two versions of The International Paediatric and Congenital Cardiac Code described above, are available for free download at http://www.IPCCC.net. These lists are also available as electronic tables from the Cardiology in the Young Website at http://journals.cambridge.org/action/displayJournal?jid=CTY.

After coding a complication as described above, qualifiers for process and outcome subsequently are added as shown in Tables 2, 3, 4, and 5. The qualifiers for process include qualifiers for relationship, timing, and preventability. These qualifiers for process were developed, in part, to understand where, in the process of the procedure, the complication occurred. First, the qualifiers for process include qualifiers to document the relationship to a defined portion of the procedure, such as related to access, or related to placement of a device (such as, in the example above, an atrial septal defect occluder resulting in tricuspid insufficiency). Second, a complication is coded for the timing of the complication, such as “after sheaths inserted” or “with device release”, etc. Third, a qualifier for process is chosen to address the “preventability” of the complication.

Table 2 Complication code qualifiers for relationship or attributability.

Table 3 Complication code qualifiers for timing.

Table 4 Complication code qualifiers for preventability and definitions.

Table 5 Complication code qualifiers for severity and definitions.

Finally, qualifiers for outcome are also chosen for each complication. These qualifiers for outcome can provide more information about a complication. For example, the complication of “Metabolic acidosis” can be followed by the final outcome, such as “Resolved, Spontaneously”. The final qualifier for outcome is for the severity of the complication (Table 5). These codes to describe severity are subjective, but help stratify the significance of the complication. Please note that the complete detailed lists of nomenclature (shown in part in Tables 1, 2, 3, 4, and 5) are all available for free download at http://www.IPCCC.net. These lists are also available as electronic tables from the Cardiology in the Young Website at http://journals.cambridge.org/action/displayJournal?jid=CTY.

Discussion

Using the structure of The International Paediatric and Congenital Cardiac Code, we have developed a comprehensive set of terms to code for the complications related to cardiac catheterisation for paediatric and congenital cardiac disease. A key feature of this set of codes is the inclusion of qualifier codes for attributability that put the complication in the context of the process of catheterisation. This feature is essential for efforts designed to improve quality.

Currently, no uniform set of terms exist to code for the complications related to cardiac catheterisation for paediatric and congenital cardiac disease. Therefore, it is impossible to compare studies from individual centres to understand what the real risk of the cardiac catheterisation is to a specific patient. This problem is best exemplified by the recent single-institution reports by Mehta and colleaguesReference Mehta, Lee, Chaturvedi and Benson15 and Bergersen and colleaguesReference Bergersen, Gauvreau, Lock and Jenkins16 that document a rate of complications of 7.3% and 19%, respectively. Standardisation of the coding of complications related to cardiac catheterisation for paediatric and congenital cardiac disease, as described in this paper, is essential for meaningful analysis of multi-institutional studies. Importantly, the nomenclature and associated codes for complications listed in this paper are identical to those within the structure of The International Paediatric and Congenital Cardiac Code where they relate to complications associated with other strategies of management, such as for surgery or arrhythmias, and are thus compatible with other existing international surgical and cardiological databases.Reference Jacobs1

Footnotes

*

Jeffrey Phillip Jacobs is Medical Advisor for CardioAccess.

References

1. Jacobs, JP (ed.). 2008 Supplement to Cardiology in the Young: Databases and the assessment of complications associated with the treatment of patients with congenital cardiac disease, prepared by: The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease. Cardiol Young 2008; 18 (Suppl 2): 1–530.Google Scholar
2. Jacobs, JP. Introduction – Databases and the assessment of complications associated with the treatment of patients with congenital cardiac disease. In: Jacobs JP (ed.). 2008 Cardiology in the Young Supplement: Databases and The Assessment of Complications associated with The Treatment of Patients with Congenital Cardiac Disease, prepared by: The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease. Cardiol Young 2008; 18 (Suppl 2): 1–37.Google Scholar
3. Jacobs, JP, Jacobs, ML, Mavroudis, C, et al. Nomenclature and databases for the surgical treatment of congenital cardiac disease – an updated primer and an analysis of opportunities for improvement. In: Jacobs JP (ed.). 2008 Cardiology in the Young Supplement: Databases and The Assessment of Complications associated with The Treatment of Patients with Congenital Cardiac Disease, prepared by: The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease, Cardiolo Young 2008; 18 (Suppl 2): 38–62.Google Scholar
4. Franklin, RCG, Jacobs, JP, Krogmann, ON, et al. Nomenclature for congenital and paediatric cardiac disease: Historical perspectives and The International Pediatric and Congenital Cardiac Code. In: Jacobs JP (ed.). 2008 Cardiology in the Young Supplement: Databases and The Assessment of Complications associated with The Treatment of Patients with Congenital Cardiac Disease, prepared by: The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease, Cardiol Young 2008; 18 (Suppl 2): 70–80.Google Scholar
5. Jenkins, KJ III, Beekman, RH, Bergersen, LJ, et al. Databases for assessing the outcomes of the treatment of patients with congenital and paediatric cardiac disease – the perspective of cardiology. In: Jacobs JP (ed.). 2008 Cardiology in the Young Supplement: Databases and The Assessment of Complications associated with The Treatment of Patients with Congenital Cardiac Disease, Prepared by: The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease, Cardiol Young 2008; 18 (Suppl 2): 116–123.Google Scholar
6. Bergersen, L, Everett, AD, Giroud, JM, et al. Report from The International Society for Nomenclature of Paediatric and Congenital Heart Disease: Cardiovascular Catheterization for Congenital and Paediatric Cardiac Disease (Part 1 – procedural nomenclature), Cardiol Young 2011; 21: 252259.CrossRefGoogle Scholar
7. Franklin, RCG, Jacobs, JP, Tchervenkov, CI, Béland, M. Report from the Executive of The International Working Group for Mapping and Coding of Nomenclatures for Paediatric and Congenital Heart Disease: bidirectional crossmap of the short lists of the European Paediatric Cardiac Code and the International Congenital Heart Surgery Nomenclature and Database Project. Cardiol Young 2002; 12 (Suppl 2): 1822.CrossRefGoogle Scholar
8. Franklin, RCG, Jacobs, JP, Tchervenkov, CI, Béland, M. European Paediatric Cardiac Code Short List crossmapped to STS/EACTS Short List with ICD-9 & ICD-10 crossmapping. Cardiol Young 2002; 12 (Suppl 2): 2349.Google Scholar
9. Franklin, RCG, Jacobs, JP, Tchervenkov, CI, Béland, M. STS/EACTS Short List mapping to European Paediatric Cardiac Code Short List with ICD-9 & ICD-10 crossmapping. Cardiol Young 2002; 12 (Suppl 2): 5062.Google Scholar
10. Béland, M, Jacobs, JP, Tchervenkov, CI, Franklin, RCG. The International Nomenclature Project for Paediatric and Congenital Heart Disease: report from the Executive of The International Working Group for mapping and coding of Nomenclatures for Paediatric and Congenital Heart Disease. Cardiol Young 2002; 12: 425430.CrossRefGoogle Scholar
11. Franklin, RCG, Jacobs, JP, Tchervenkov, CI, Béland, M. The International Nomenclature Project for Pediatric and Congenital Heart Disease: Bidirectional crossmap of the short lists of the European Paediatric Cardiac Code and the International Congenital Heart Surgery Nomenclature and Database Project. Cardiol Young 2002; 12: 431435.CrossRefGoogle Scholar
12. Béland, MJ, Franklin, RCG, Jacobs, JP, et al. Update from The International Working Group for mapping and coding of nomenclatures for Paediatric and Congenital Heart Disease. Cardiol Young 2004; 14: 225229.CrossRefGoogle Scholar
13. Bergersen, L, Marshall, A, Gauvreau, K, et al. Adverse event rates in congenital cardiac catheterization – a multi-center experience. Catheter Cardiovasc Interv 2009; 75: 389400.CrossRefGoogle Scholar
14. Everett, AD, Ringel, R, Rhodes, JF, et al. Development of the MAGIC Congenital Heart Disease Catheterization Database for Interventional Outcome Studies. J Invasive Cardiol 2006; 19: 173177.Google ScholarPubMed
15. Mehta, R, Lee, KJ, Chaturvedi, R, Benson, L. Complications of pediatric cardiac catheterization: a review in the current era. Catheter Cardiovasc Interv 2008; 72: 278285.CrossRefGoogle ScholarPubMed
16. Bergersen, L, Gauvreau, K, Lock, JE, Jenkins, KJ. A risk adjusted method for comparing adverse outcomes among practitioners in pediatric and congenital cardiac catheterization. Congenit Heart Dis 2008; 3: 230240.CrossRefGoogle ScholarPubMed
Figure 0

Table 1 Complication code hierarchy main categories (level 2).

Figure 1

Table 2 Complication code qualifiers for relationship or attributability.

Figure 2

Table 3 Complication code qualifiers for timing.

Figure 3

Table 4 Complication code qualifiers for preventability and definitions.

Figure 4

Table 5 Complication code qualifiers for severity and definitions.