Aortic Valve Surgery - Replacement Biological – Aortic Valve Surgery - Replacement Mechanical – Mitral Valve Surgery Repair – Mitral Valve Surgery - Replacement Biological – Mitral Valve Surgery - Replacement Mechanical – Tricuspid Valve Surgery - Repair DeVega – Tricuspid Valve Surgery - Repair Ring – Tricuspid Valve Surgery - Repair Other – Tricuspid Valve Surgery Replacement - Biological – Tricuspid Valve Surgery Replacement - Mechanical – Pulmonary Valve Surgery - Repair Pulmonary Valve Surgery Replacement - Biological – Pulmonary Valve Surgery Replacement - Mechanical – Other Cardiac Surgical Procedure - textbox Cardiac Surgical Procedure Unknown – Other Procedures: Reintubation due to Respiratory Failure Dialysis Bronchoscopy Other, specify - textbox PUMP CHANGE Please answer all questions regarding pump status considering all time since - previous visit and current follow-up date. Was there a pump exchange of a para- or extra- corporeal pump? Example: PVAD, Berlin Heart. Yes, No, or Unknown If yes, Please select the Pump Exchange Reason: Thrombus NOT associated with hemolysis Change in hemodynamics Clinical status Device parameters (please enter Device Malfunction Form) Upsizing device because of patient growth status All other reasons would categorize the pump change as a Device Malfunction. If selected, please fill out the Device Malfunction Form. Was there a console change? For TAH or Berlin Heart Consoles. Yes, No, or Unknown If Yes please complete the following: Date of console change: Enter date in MMDDYYYY format. ST= Unknown Original console name: Text. New console name: Text. Major Outcomes and Adverse Events
Aortic Valve Surgery - Replacement – Biological Aortic Valve Surgery - Replacement – Mechanical Mitral Valve Surgery – Repair Mitral Valve Surgery - Replacement – Biological Mitral Valve Surgery - Replacement – Mechanical Tricuspid Valve Surgery - Repair – DeVega Tricuspid Valve Surgery - Repair – Ring Tricuspid Valve Surgery - Repair – Other Tricuspid Valve Surgery – Replacement - Biological Tricuspid Valve Surgery – Replacement - Mechanical Pulmonary Valve Surgery - Repair Pulmonary Valve Surgery – Replacement - Biological Pulmonary Valve Surgery – Replacement - Mechanical Other Cardiac Surgical Procedure - textbox Cardiac Surgical Procedure – Unknown Other Procedures: Reintubation due to Respiratory Failure Dialysis Bronchoscopy Other, specify - textbox PUMP CHANGE - Please answer all questions regarding pump status considering all time since previous visit and current follow-up date. Was there a pump exchange of a para- or extra- corporeal pump? Example: PVAD, Berlin Heart. Yes, No, or Unknown If yes, Please select the Pump Exchange Reason: Thrombus NOT associated with hemolysis Change in hemodynamics Clinical status Device parameters (please enter Device Malfunction Form) Upsizing device because of patient growth status All other reasons would categorize the pump change as a Device Malfunction. If selected, please fill out the Device Malfunction Form. Was there a console change? For TAH or Berlin Heart Consoles. Yes, No, or Unknown If Yes please complete the following: Date of console change: Enter date in MMDDYYYY format. ST= Unknown Original console name: Text. New console name: Text. Major Outcomes and Adverse Events
STS_Intermacs.docx