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Presentation of the International Nomenclature for Congenital Heart Surgery.

The
long way from nomenclature to collection of validated data at the EACTS
François Lacour-Gayet, Bohdan Maruszewski, Constantine Mavroudis, Jeffrey P. Jacobs
and Martin J. Elliott
Eur J Cardiothorac Surg 2000;18:128-135

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The European Journal of Cardio-thoracic Surgery is the official Journal of the European Association
for Cardio-thoracic Surgery and the European Society of Thoracic Surgeons. Copyright © 2000 by
European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved. Print
ISSN: 1010-7940.

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European Journal of Cardio-thoracic Surgery 18 (2000) 128±135
www.elsevier.com/locate/ejcts
Editorial

Presentation of the International Nomenclature for Congenital Heart


Surgery. The long way from nomenclature to collection of validated data
at the EACTS
FrancËois Lacour-Gayet*, Bohdan Maruszewski, Constantine Mavroudis,
Jeffrey P. Jacobs, Martin J. Elliott
CHD Committee at the EACTS, Marie Lannelongue Hospital, 133 Avenue de la ReÂsistance, 92350 Le Plessis Robinson, France
Received 20 December 1999; received in revised form 11 April 2000; accepted 18 April 2000

Summary
An International Nomenclature for Congenital Heart Surgery was of®cially adopted at the Annual Meeting of the EACTS in Glasgow, UK
on September 6, 1999. This nomenclature was achieved following 1 year's work of the International Nomenclature and Data Base Committee
for Congenital Heart Surgery of the Society of Thoracic Surgeons. This international group included members from the STS, AATS, AHA
and EACTS and associated surgeons and cardiologists from United States, Canada, Australia and Europe. The Nomenclature includes a
minimal data set of 21 items and lists of 150 diagnoses, 200 procedures, 32 complications and 28 extra cardiac anomalies and preoperative
risk factors. It will serve as a basis for the Pediatric European Cardiac Surgical Registry (http://www.pediatric.ecsur.org). The outcome of
such an International Nomenclature represents an important event for the medical community in charge of treating patients with congenital
heart diseases. It will allow scienti®c exchanges on an international scale and promote multicenter evaluation of congenital heart surgery.
Nevertheless, this Nomenclature is only the ®rst step. Further collection of validated data at the Pediatric ECSUR Data Base requires ethical
belief, time consumption and ®nancial resources. Comparison of results, according to pathologies, across centers and countries will help
de®ne, in the future, of®cial European standards of Quality of Care available for health care organizations, public scrutiny and governmental
agencies. q 2000 Elsevier Science B.V. All rights reserved.

1. Introduction 2. Outcome of an International Nomenclature for


Congenital Heart Surgery
The need for an International Nomenclature for congeni-
tal heart surgery (CHD) is requested to unify the data bases An International Nomenclature for Congenital Heart
produced in the world. A common language is mandatory to Surgery was of®cially adopted at the Business Meeting of
enhance communication between the diagnosis and thera- the EACTS in Glasgow, UK on September 6, 1999.
peutic `forces' enrolled in the treatment of congenital heart This achievement was the conclusion of a 12-month inter-
diseases. A uni®ed Nomenclature allows large multicenter national project chaired by Constantine Mavroudis and
studies that are able to produce numerous research projects Jeffrey Jacobs, along with the International Nomenclature
in epidemiology, pathology, therapeutics and health care and Data Base Committee (Appendix A) for CHD of the
management. Society of Thoracic Surgeons (STS). This international
An International Nomenclature opens the ®elds of group of 36 physicians included members from the STS,
advanced and adapted data bases. Nevertheless, an Interna- AATS, AHA and EACTS and associated surgeons and
tional Nomenclature is only the ®rst step towards collection cardiologists from the United States, Canada, Australia
of validated data that implies time consumption, moral and Europe. Members of this Committee have met at
belief and ®nancial resources. eight conferences from September 1998 to November
1999 to ®nalize this project:

1. The First International Nomenclature Conference for


* Corresponding author. Fax: 133-1-4094-5581. Pediatric Cardiac Surgery, Chicago, IL, USA, September
E-mail address: ¯acourgayet@ccml.com (F. Lacour-Gayet). 19±20, 1998;
1010-7940/00/$ - see front matter q 2000 Elsevier Science B.V. All rights reserved.
PII: S10 10-7940(00)0046 3-2
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F. Lacour-Gayet et al. / European Journal of Cardio-thoracic Surgery 18 (2000) 128±135 129

2. The Second International Nomenclature Conference for a list of 150 diagnoses (Table 2);
Pediatric Cardiac Surgery, San Antonio, TX, USA, Janu- a list of 200 procedures (Table 3);
ary 23, 1999; a list of 32 complications (Table 4);
3. The Spring Meeting of the European Congenital Heart a list of 28 extra cardiac anomalies and preoperative risk
Surgeons Foundation, Rome, Italy, April 10, 1999; factors (Table 5).
4. The Third International Nomenclature Conference for
The period of data collection for the minimum data set
Pediatric Cardiac Surgery, New Orleans, LA, USA,
will end when both of the following two criteria have been
April 23, 1999;
satis®ed:
5. The International Nomenclature for Pediatric Cardiac
Surgery Subcommittee Meeting, Orlando, FL, USA, the patient has been discharged from the hospital after the
August 14±15, 1999; operation;
6. The Congenital Heart Surgery Business Meeting of the 30 days have passed since the operation.
European Association for Cardiothoracic Surgery, 13th
Operative mortality designates any death occurring
Annual Meeting of the EACTS, Glasgow, Scotland, UK,
during the period of data collection, regardless of whether
September 5±8, 1999;
or not the mortality is related to surgery.
7. The Subcommittee Meeting of the International Nomen-
clature for Pediatric Cardiac Surgery Advisory Editorial
Committee at the 9th Annual Farouk S. Idriss, M.D. 4. The Pediatric European Cardiac Surgical Registry
Lecture, Chicago, IL, USA, October 1±2, 1999. (ECSUR)
The aim of this cooperative committee was to create an
The CHD Committee of the EACTS has decided in Glas-
International Language for CHD that ful®lls the following
gow that the Congenital Heart Surgery Data Base will be
requirements:
hosted by Dr Bohdan Maruszewski in Warsaw, Poland,
being simple, limited and exclusive; under the authority of the Data Base Committee of the
complete; EACTS in compliance with the requirement of the
usable by surgeons and cardiologists; ECSUR project. The EACTS pediatric data base is named
including: cardiac surgery, lung surgery, ECMO proce- the Pediatric European Cardiac Surgical Registry (ECSUR)
dures, arrhythmia procedures; and is available at http://www.pediatric.ecsur.org. A simpli-
respecting all published classi®cation; ®ed Data Base software using the new International Nomen-
providing synonyms for similar items. clature, that has been developed under the auspices of the
ECHSF (Appendix B), can be downloaded free of charge at
Participants of this Committee have produced an article on
http://www.pediatric.ecsur.org since December 1999 so that
an assigned issue covering all the pathologies mentioned.
the data collection can start in 2000. European centers
These articles, published in a Supplement of Annals of
performing pediatric cardiac surgery are expected to regis-
Thoracic Surgery (April, 2000) [1], include analyses of all
ter to the ECSUR pediatric program and send their data.
existing anatomic classi®cations and nomenclature systems
As The Pediatric ECSUR Data Base is equipped with a
for the comprehensive data set and the minimum data set.
widely compatible system, other software respecting the Inter-
The comprehensive data set includes all the imagined vari-
national Nomenclature can also be used, provided that it
ables, in a hierarchical scheme, which are detailed enough to
strictly respects the minimal data set of the International
generate risk strati®cation analyses. The minimum data set
Nomenclature as it appears at the Pediatric ECSUR web site.
will include short lists that would create an essential data
set, which would be mandatory for data sharing and would
lend itself to basic interpretation of trends. 5. Mapping with other existing coding
The EACTS has decided to use for its data base the mini-
mum data set which, in most cases, stems from the ®rst or The Association for European Pediatric Cardiology
second level of hierarchy of the STS comprehensive data (AEPC) has published its own coding [2]. A joint committee
set. This minimum data set and short lists form the Interna- from the EACTS and the AEPC will develop a mapping
tional Nomenclature for CHD Surgery. system to allow connections between the two data bases.

6. Collection of validated data and evaluation of quality


3. How to use the International Nomenclature
of care
The Nomenclature includes ®ve main lists to be
Validation of true data on a large scale is a challenging
respected:
task. Complete and true data imply an ethical belief and
a minimum data set of 21 mandatory items and seven probably `a validation' committee inside the EACTS that
optional items (Table 1); will be in charge of inspecting locally the quality and the

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130 F. Lacour-Gayet et al. / European Journal of Cardio-thoracic Surgery 18 (2000) 128±135

exactness of the data sent to the Pediatric ECSUR. Table 2


However, studies on clinical research require explorative List of diagnoses
aspects that cannot be coded in an exclusive coding. Such Septal defects
research is better achieved in limited groups of work and ASD PFO
requires a more comprehensive coding. Evaluation of qual- ASD, secundum
ity of care is a ®nal goal that the EACTS envisions for the ASD, sinus venosus
ASD, coronary sinus
future. In this regard, a committee for de®nition of Strati®-
ASD, common atrium (single atrium)
cation Risk in Congenital Heart Surgery, attached to the ASD, NOS
CHD Committee, will soon be created. VSD VSD, single
VSD, multiple
VSD, NOS
AV canal AVC (AVSD), complete (CAVSD)
7. Conclusion AVC (AVSD), intermediate
(transitional)
AVC (AVSD), partial (incomplete)
The outcome of an International Nomenclature for
(PAVSD) (ASD, primum)
Congenital Heart Surgery is an important event for the AVC (AVSD), NOS
Medical Community in charge of treating patients with AP window AP window (aortopulmonary window)
Congenital Heart Diseases. It represents an important ®rst Pulmonary artery origin from ascending
step on the long way towards collection of validated data. aorta (hemitruncus)
Truncus arteriosus Truncus arteriosus

Pulmonary venous anomalies


Table 1
Partial anomalous pulmonary Partial anomalous pulmonary venous
Minimum data set
venous Connection connection (PAPVC)
Mandatory items Partial anomalous pulmonary venous
1 Unique identifying number M connection (PAPVC), scimitar
2 Last name M Total anomalous pulmonary Total anomalous pulmonary venous
3 First name M venous Connection connection (TAPVC), Type 1
4 Date of birth M (Supracardiac)
5 Gender M Total anomalous pulmonary venous
6 Date of admission M connection (TAPVC), Type 2 (Cardiac)
7 Non-cardiac abnormalities/general preoperative M Total anomalous pulmonary venous
risk factors (From `Non-cardiac Abnormalities/ connection (TAPVC), Type 3
General Preoperative Risk Factors List') (Infracardiac)
8 Number of prior cardiothoracic operations M Total anomalous pulmonary venous
9 Date of surgery M connection (TAPVC), Type 4 (Mixed)
10 Case category (CPB, non-CPB, ECMO, Thoracic, M Total anomalous pulmonary venous
Interventional Cardiology, Other) connection (TAPVC), NOS
11 Weight at operation M Cor triatriatum Cor triatriatum
12 Diagnosis (Primary diagnosis and Additional M Pulmonary venous stenosis Pulmonary venous stenosis
diagnoses from `Diagnoses List')
13 Operation (Primary procedure and Additional M Systemic venous anomalies
procedures from `Procedures List') Anomalous systemic venous Systemic venous anomaly
14 Surgeon M connection Systemic venous obstruction
15 Aortic cross-clamp time M
16 Circulatory arrest time M Right heart lesions
17 Complications (from `Complications List') M Tetralogy TOF
18 Reoperation during this admission? (Yes or No) M TOF, AVC (AVSD)
19 Date of discharge M TOF, absent pulmonary valve
20 Date of mortality M Pulmonary atresia Pulmonary atresia
21 Operative Mortality? (Yes or No) M Pulmonary atresia ± IVS
Pulmonary atresia ± VSD (including
Optional items TOF, PA)
1 Antenatal diagnosis? (Yes or No) O Pulmonary atresia ± VSD ± MAPCA
2 Height at operation O (Pseudotruncus)
3 Consultant/attending O MAPCA(s) (major aortopulmonary
4 Resident O collateral(s)) (Pseudotruncus)
5 Cardiopulmonary bypass time (does not include O Tricuspid valve disease and Ebstein's anomaly
circulatory arrest time) Ebstein's anomaly Tricuspid regurgitation, non-Ebstein's
6 Is this operation a reoperation during this O related
admission? (`No', `Yes ± Planned reoperation', or Tricuspid stenosis
`Yes ± Unplanned reoperation') Tricuspid regurgitation and tricuspid
7 Mortality assigned to this operation? (Yes or No) O stenosis

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F. Lacour-Gayet et al. / European Journal of Cardio-thoracic Surgery 18 (2000) 128±135 131

Table 2 (continued) Table 2 (continued)


Tricuspid valve, other DORV, NOS
RVOT obstruction, IVS Pulmonary stenosis, valvar
Pulmonary stenosis Pulmonary artery stenosis (hypoplasia), DOLV
Main (Trunk) DOLV DOLV
Pulmonary artery stenosis, branch,
central Thoracic arteries and veins
Pulmonary artery stenosis, Branch, Anomalous origin of coronary Anomalous origin of coronary artery
Peripheral (beyond the hilar bifurcation) artery from pulmonary artery
Pulmonary stenosis, NOS Coarctation of aorta (All Coarctation of aorta
DCRV types) Aortic arch hypoplasia
Pulmonary valve, other Coronary artery ®stula Coronary artery anomalies
Conduit stenosis/insuf®ciency Conduit failure Interrupted arch Interrupted aortic arch
Pulmonary insuf®ciency Pulmonary insuf®ciency Patent ductus arteriosus Patent ductus arteriosus
Pulmonary insuf®ciency and pulmonary Vascular rings and slings Vascular ring
stenosis Pulmonary artery sling
Aortic aneurysm Aortic aneurysm (including
Left heart lesions pseudoaneurysm)
Aortic valve disease Aortic stenosis, subvalvar Aortic dissection
Aortic stenosis, valvar
Aortic stenosis, supravalvar Lung disease
Aortic stenosis, NOS Lung disease Lung disease, benign
Aortic valve atresia Lung disease, malignant
Aortic insuf®ciency Pectus excavatum, carinatum Pectus
Aortic insuf®ciency and aortic stenosis Tracheal stenosis Tracheal stenosis
Aortic valve, other Tracheal disease, other
Sinus of Valsalva ®stula/ Sinus of Valsalva aneurysm
aneurysm Electrophysiologic
LV to aorta tunnel LV to aorta tunnel Electrophysiologic Arrhythmia
Mitral valve disease Mitral stenosis, supravalvar mitral ring Arrhythmia, heart block, acquired
Mitral stenosis, valvar Arrhythmia, heart block, congenital
Mitral stenosis, subvalvar Arrhythmia, Heart block, NOS
Mitral stenosis, subvalvar, parachute Arrhythmia, pacemaker, indication for
Mitral stenosis, NOS replacement
Mitral regurgitation and mitral stenosis
Mitral regurgitation Miscellaneous
Mitral valve, other Atrial isomerism, left
Hypoplastic left heart Hypoplastic left heart syndrome (HLHS) Atrial isomerism, right
Cardiomyopathy Cardiomyopathy Aneurysm, ventricular, right
Constrictive pericarditis Pericardial effusion Aneurysm, ventricular, left
Pericarditis Aneurysm, pulmonary artery
Pericardial disease, other Aneurysm, other
Hypoplastic RV
Single ventricle Hypoplastic LV
Single ventricle Single ventricle, DILV Mediastinitis
Single ventricle, DIRV Endocarditis
Single ventricle, mitral atresia Prosthetic valve failure
Single ventricle, tricuspid atresia Myocardial infarction
Single ventricle, unbalanced AV canal Cardiac tumor
Single ventricle, heterotaxia syndrome Pulmonary AV ®stula
Single ventricle, other Pulmonary embolism
Single ventricle, NOS Pulmonary vascular obstructive disease,
NOS
Transposition of the great arteries Pulmonary vascular obstructive disease
Congenitally corrected TGA Congenitally corrected TGA (Eisenmenger's)
Transposition of the great TGA, IVS Primary pulmonary hypertension
arteries TGA, IVS ± LVOTO Persistent fetal circulation
TGA, VSD Meconium aspiration
TGA, VSD ± LVOTO Pleural disease, benign
TGA, NOS Pleural disease, malignant
DORV Pneumothorax
DORV DORV, VSD type Pleural effusion
DORV, TOF type Chylothorax
DORV, TGA type Empyema
DORV, Remote VSD (Uncommitted Esophageal disease, benign
VSD) Esophageal disease, malignant

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132 F. Lacour-Gayet et al. / European Journal of Cardio-thoracic Surgery 18 (2000) 128±135

Table 2 (continued) Table 3 (continued)


Mediastinal disease, benign TOF repair, RV-PA conduit
Mediastinal disease, malignant TOF, AVC (AVSD), repair
Diaphragm paralysis TOF, absent pulmonary valve, repair
Diaphragm disease, other TOF repair, NOS
Cardiac, other Pulmonary atresia Pulmonary atresia ± VSD (including TOF, PA),
Thoracic and/or mediastinal, other repair
Peripheral vascular, other Pulmonary atresia ± VSD ± MAPCA
Miscellaneous, other (Pseudotruncus), repair
Normal heart Unifocalization MAPCA(s)
Occlusion MAPCA(s)
Tricuspid valve Valvuloplasty, tricuspid
disease and Valve replacement, tricuspid (TVR)
Ebstein's anomaly Valve closure, tricuspid (exclusion,
univentricular approach)
Table 3 Valve excision, tricuspid (without replacement)
List of surgical procedures Valve surgery, other, tricuspid
RVOT obstruction, RVOT procedure
Septal defects IVS
ASD PFO, primary closure Pulmonary stenosis 1 1/2 ventricular repair
ASD repair, primary closure PA, reconstruction (plasty)
ASD repair, patch PA, reconstruction (plasty), main (trunk)
ASD repair, device PA, reconstruction (plasty), branch, central
ASD, common atrium (Single atrium), Septation PA, reconstruction (plasty), branch, Peripheral
ASD creation/enlargement (beyond the hilar bifurcation)
ASD partial closure DCRV repair
Atrial septal fenestration Conduit stenosis/ Conduit reoperation
ASD repair, NOS insuf®ciency
VSD VSD repair, primary closure Pulmonary Valvuloplasty, pulmonic
VSD repair, patch insuf®ciency Valve replacement, pulmonic (PVR)
VSD repair, device Conduit, placement, RV to PA
VSD, multiple, repair Conduit, placement, LV to PA
VSD creation/enlargement Valve surgery, other, pulmonic
Ventricular septal fenestration Left heart lesions
VSD repair, NOS Aortic valve disease Valvuloplasty, aortic
AV canal AVC (AVSD) repair, complete (CAVSD) Valve replacement, aortic (AVR)
AVC (AVSD) repair, Intermediate (transitional) Valve replacement, aortic (AVR), Mechanical
AVC (AVSD) repair, partial (incomplete) Valve replacement, aortic (AVR), Bioprosthetic
(PAVSD) Valve replacement, aortic (AVR), Homograft
AVC (AVSD) repair, NOS Aortic root replacement
AP window AP window repair Aortic root replacement, mechanical
Pulmonary artery origin from ascending aorta Aortic root replacement, homograft
(Hemitruncus) repair Ross procedure
Truncus arteriosus Truncus arteriosus repair Konno procedure
Ross±Konno procedure
Pulmonary venous anomalies Other annular enlargement procedure
Partial anomalous PAPVC repair Aortic stenosis, subvalvar, repair
pulmonary venous PAPVC, scimitar, Repair Aortic stenosis, supravalvar, repair
connection Valve surgery, other, aortic
Total anomalous TAPVC repair Sinus of Valsalva Sinus of Valsalva, aneurysm repair
pulmonary venous ®stula/aneurysm
connection LV to aorta tunnel LV to aorta tunnel repair
Cor triatriatum Cor triatriatum repair Mitral valve disease Valvuloplasty, mitral
Pulmonary venous Pulmonary venous stenosis repair Mitral stenosis, supravalvar mitral ring, repair
stenosis Valve replacement, mitral (MVR)
Valve surgery, other, mitral
Systemic venous anomalies Hypoplastic left heart Norwood procedure
Anomalous systemic Atrial baf¯e procedure (non-Mustard, non- HLHS biventricular repair
venous connection Senning) Transplant, heart
Anomalous systemic venous connection repair Cardiomyopathy Transplant, heart
Systemic venous stenosis repair Transplant, heart and lung
Partial left ventriculectomy (LV volume
Right heart lesions reduction surgery) (Batista)
Tetralogy TOF repair, no ventriculotomy Constrictive Pericardial drainage procedure
TOF repair, ventriculotomy, non-transanular pericarditis Pericardiectomy
patch Pericardial procedure, other
TOF repair, ventriculotomy, transanular patch

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F. Lacour-Gayet et al. / European Journal of Cardio-thoracic Surgery 18 (2000) 128±135 133

Table 3 (continued) Table 3 (continued)

Single ventricle Lung disease


Single ventricle Fontan, atrio-pulmonary connection Lung disease Lung biopsy
Fontan, atrio-ventricular connection Transplant, lung(s)
Fontan, TCPC, lateral tunnel, fenestrated Lung procedure, other
Fontan, TCPC, lateral tunnel, non-fenestrated Pectus excavatum, Pectus repair
Fontan, TCPC, lateral tunnel, NOS carinatum
Fontan, TCPC, external conduit, fenestrated Tracheal stenosis Tracheal procedure
Fontan, TCPC, external conduit, non-fenestrated
Fontan, TCPC, external conduit, NOS Electrophysiologic
Fontan, other Electrophysiologic Pacemaker implantation, permanent
Fontan, NOS Pacemaker procedure
Additional procedures are listed under the ICD (AICD) implantation
Palliative procedures section so as to avoid ICD (AICD) ((automatic) implantable
repetitive listings. However, these procedures cardioverter de®brillator) procedure
will be discussed in the Single Ventricle paper. Arrhythmia surgery ± atrial, surgical Ablation
Arrhythmia surgery ± ventricular surgical
Transposition of the great arteries Ablation
Congenitally Congenitally corrected TGA repair, atrial Switch
corrected TGA and ASO (Double switch) Interventional cardiology procedures
Congenitally corrected TGA repair, atrial switch ASD creation, balloon septostomy (BAS)
and Rastelli (Rashkind)
Congenitally corrected TGA repair, VSD ASD creation, blade septostomy
closure Balloon dilation
Congenitally corrected TGA repair, VSD Stent placement
closure and LV to PA conduit Device closure
Congenitally corrected TGA repair, other RF ablation
Congenitally corrected TGA repair, NOS Coil embolization
Transposition of the Arterial switch operation (ASO)
great arteries Arterial switch operation (ASO) and VSD repair Palliative procedures
Senning Shunt, Systemic to pulmonary, modi®ed
Mustard Blalock±Taussig shunt (MBTS)
Rastelli Shunt, systemic to pulmonary, central (From
REV aorta or to main pulmonary artery)
TGA, other procedures (Nikaido, Kawashima, Shunt, systemic to pulmonary, other
LV-PA conduit, other) Shunt, systemic to pulmonary, NOS
DORV Shunt, ligation and takedown
DORV DORV, intraventricular tunnel repair PA banding (PAB)
DORV repair, NOS PA debanding
Damus±Kaye±Stansel procedure (DKS)
DOLV (creation of AP anastomosis without arch
DOLV DOLV repair reconstruction)
Bidirectional cavopulmonary anastomosis
Thoracic arteries and veins (BDCPA) (bidirectional Glenn)
Anomalous origin of Anomalous origin of coronary artery from Glenn (unidirectional cavopulmonary
coronary artery pulmonary artery repair anastomosis) (unidirectional Glenn)
Coarctation of aorta Coarctation repair, end to end Bilateral bidirectional cavopulmonary
(all types) Coarctation repair, end to end, extended anastomosis (BBDCPA) (bilateral bidirectional
Coarctation repair, subclavian ¯ap Glenn)
Coarctation repair, patch aortoplasty Hemifontan
Coarctation repair, interposition graft Palliation, other
Coarctation repair, other
Coarctation repair, NOS Miscellaneous
Aortic arch repair Aneurysm, ventricular, right, repair
Coronary artery Coronary artery ®stula ligation Aneurysm, ventricular, left, repair
®stula Coronary artery bypass Aneurysm, pulmonary artery, repair
Coronary artery procedure, other Cardiac tumor resection
Interrupted arch Interrupted aortic arch repair Pulmonary AV ®stula repair/occlusion
Patent ductus PDA closure, surgical Pulmonary embolectomy
arteriosus PDA closure, device Pleural drainage procedure
PDA closure, NOS Pleural procedure, other
Vascular rings and Vascular ring repair Decortication
slings Pulmonary artery sling repair Esophageal procedure
Aortic aneurysm Aortic aneurysm repair Mediastinal procedure
Aortic dissection repair Intra-aortic balloon pump (IABP) insertion

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134 F. Lacour-Gayet et al. / European Journal of Cardio-thoracic Surgery 18 (2000) 128±135

Table 3 (continued) Table 5


ECMO procedure List of extra cardiac anomalies and preoperative factors
Right/left heart assist device procedure
Mediastinal exploration Asplenia
Bronchoscopy Polysplenia
Diaphragm plication Down's syndrome
Diaphragm procedure, other Turner's syndrome
VATS (video assisted thoracoscopic surgery) DiGeorge
Minimally invasive procedure Williams Beuren syndrome
Bypass for non-cardiac lesion Alagille syndrome (Intra-hepatic biliary duct agenesis)
Delayed sternal closure 22q11 deletion
Mediastinal exploration Other chromosomal abnormality
Sternotomy wound drainage Rubella
Thoracotomy, other Marfan's syndrome
Cardiotomy, other Preoperative mechanical circulatory support (IABP,
Cardiac procedure, other VAD, ECMO, or CPS)
Thoracic and/or mediastinal procedure, other Preoperative complete AV block
Peripheral vascular procedure, other Preoperative arrhythmia
Miscellaneous procedure, other Preoperative shock
Preoperative acidosis
Preoperative pulmonary hypertension crises (PA
pressure . systemic pressure)
Preoperative mechanical ventilatory support
Preoperative tracheostomy
Preoperative renal failure (Creatinine . 2)
Preoperative renal failure requiring dialysis
Preoperative bleeding disorder
Preoperative endocarditis
Preoperative septicemia
Table 4 Preoperative neurological de®cit
List of complications Preoperative seizures
Other preoperative non-cardiac abnormality
Reoperation during this admission (unplanned reoperation)
Other preoperative risk factor
Postoperative cardiac arrest
Postoperative mechanical circulatory support (IABP, VAD, ECMO, or
CPS)
Postoperative complete AV block requiring temporary pacemaker Appendix A. Committee of International Nomenclature
Postoperative complete AV block requiring permanent pacemaker and Data Base for Congenital Heart Surgery at the
Postoperative arrhythmia
Postoperative low cardiac output
Society of Thoracic Surgeons
Postoperative acidosis
Sternum left opened
Pericardial effusion requiring drainage
Carl L. Backer, M.D., Chicago, IL, USA
Systemic vein obstruction Redmond P. Burke, M.D., Miami, FL, USA
Pulmonary vein obstruction Duke Cameron, M.D., Baltimore, MD, USA
Postoperative pulmonary hypertension crises (PA pressure . systemic Andrew D. Cochrane F.R.A.C.S., Melbourne, Australia
pressure) Victor F. Chu, M.D., Montreal, Canada
Postoperative respiratory insuf®ciency requiring mechanical ventilatory
support . 7 days
Gordon Danielson, M.D., Rochester, MN, USA
Postoperative tracheostomy Barbara J. Deal, M.D., Chicago, IL, USA
Pneumonia Joseph A. Dearani, M.D., Rochester, MN, USA
Pneumothorax Ralph Delius, M.D., Davis, CA, USA
Pleural effusion requiring drainage Martin J. Elliott, M.D., F.R.C.S., London, UK
Chylothorax
Acute renal failure requiring temporary dialysis
J. William Gaynor, M.D., Philadelphia, PA, USA
Acute renal failure requiring permanent dialysis Rene Herlong, M.D., Durham, NC, USA
Bleeding requiring reoperation Andreas Hoschtitzky, M.D., London, UK
Wound dehiscence Jeffrey Jacobs, M.D., St. Petersburg, FL, USA
Wound infection Marshall L. Jacobs, M.D., Philadelphia, PA, USA
Mediastinitis
Postoperative endocarditis
James Jaggers, M.D., Durham, NC, USA
Postoperative septicemia Tom R. Karl, M.D., Melbourne, Australia
Phrenic nerve injury/paralyzed diaphragm FrancËois Lacour-Gayet, M.D., Paris, France
Recurrent laryngeal nerve injury/paralyzed vocal cord John J. Lamberti, M.D., San Diego, CA, USA
Postoperative neurological de®cit persisting at discharge Bohdan Maruszewski, M.D., Warsaw, Poland
Postoperative new onset seizures
Other postoperative complication
Constantine Mavroudis, M.D., Chicago, IL, USA
John E. Mayer Jr., M.D., Boston, MA, USA

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F. Lacour-Gayet et al. / European Journal of Cardio-thoracic Surgery 18 (2000) 128±135 135

John L. Myers, M.D., Hershey, PA, USA Martin J. Elliott, London, UK


Khanh H. Nguyen, M.D., New York, NY, USA Siegfried Hagl, Heidelberg, Germany
James A. Quintessenza, M.D., St. Petersburg, FL, USA Vladimir Ilyn, Moscow, Russia
W. Steves Ring, M.D., Dallas, TX, USA FrancËois Lacour-Gayet, Paris, France
Albert P. Rocchini, M.D., Ann Arbor, MI, USA Harald L. Lindberg, Oslo, Norway
Natalie Roy, M.D., Montreal, Canada Bohdan Maruzewski, Warsaw, Poland
Robert M. Sade, M.D., Charleston, SC, USA GoÈsta Pettersson, Cleveland, OH, USA
Thomas L. Spray, M.D., Philadelphia, PA, USA Jean Rubay, Brussels, Belgium
Jaroslav Stark, M.D., London, UK Heikki Sairanen, Helsinki, Finland
Steven A. Tahta, Montreal, Canada Babulal Sethia, London, UK
Christo I. Tchervenkov, M.D., Montreal, Canada Aram K. Smolinsky, Tel-Hashomer, Israel
Ross M. Ungerleider, M.D., Durham, NC, USA Giovanni Stellin, Padova, Italy
Henry L. Walters, M.D., Detroit, MI, USA Andreas Urban, St. Augustin, Germany
Paul Weinberg, M.D., Philadelphia, PA, USA Pascal VouheÂ, Paris, France
James L. Wilkinson, M.D., Melbourne, Australia Carin Von Doorn, Leeds, UK
Alfred E. Wood, Dublin, Ireland
Gerhard Ziemer, Tubingen, Germany
Appendix B. European Congenital Heart Surgeons
Foundation (ECHSF)

Hakan Berggren, Goteborg, Sweden References


William J. Brawn, Birmingham, UK
Thierry Carrel, Bern, Switzerland [1] Mavroudis C, Jacobs JP. Congenital heart surgery nomenclature and
Juan V. Comas, Madrid, Spain data base project: introduction and overview. Ann Thorac Surg
2000;69:S1±S372.
Antonio F. Corno, Lausanne, Switzerland
[2] Franklin RCG, Anderson RH, Daniels O, Elliott M, Gewillig M, Ghisla
Giancarlo Crupi, Bergamo, Italy R, Krogmann ON, Ulmer HE, Stocker FP. Report of the Coding
Duccio Di Carlo, Roma, Italy Committee of the Association for European Pediatric Cardiology.
Tjark Ebels, Groningen, The Netherlands Cardiol Young 1999;9:633±665.

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Presentation of the International Nomenclature for Congenital Heart Surgery. The
long way from nomenclature to collection of validated data at the EACTS
François Lacour-Gayet, Bohdan Maruszewski, Constantine Mavroudis, Jeffrey P. Jacobs
and Martin J. Elliott
Eur J Cardiothorac Surg 2000;18:128-135
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