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I assume that this procedure is always done with fluoroscopic guidance. The odd thing is that when I did a search on Google for "Percutaneous replacement of aortic valve using fluoroscopic guidance" I got only 954 hits. Using "Percutaneous replacement of aortic valve" I got 9,040 hits. The surgery is typically called transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI). A search on TAVI resulted with 9,160,000 and TAVR with 787,000 hits. Neither of these acronyms are in the current international release.

I have received reports in my office for the procedure "Percutaneous aortic valve replacement (PAVR), also known as transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR). SNOMED has the concept did not include "using fluoroscopic guidance" as part of the procedure name. The only entry in SNOMED for this is "Percutaneous replacement of aortic valve using fluoroscopic guidance (procedure)".

I guess it depends on the editorial policy whether or not the "using fluoroscopic guidance" should be included as part of the procedure name.

Since the usual clinical practice with procedure reports is to not include "using fluoroscopic guidance" users may feel that the longer name is an overspecification and may be reluctant to select this as the appropriate concept. The acronyms TAVI and TAVR are not in the current release of SCT.

Any Comments?

Contributors (2)

4 Comments

  1. Monica Harry

    Hi Ray,

    First of all, thank you for your inquiry. This is very helpful as we on the inside constantly need to be made aware of what happens in the external, real world applications.

    Interestingly, we have a new concept which will be in the January 2017 release including FSN as you suggest and synonyms with acronyms as follows :

    Transcatheter aortic valve replacement (procedure)  

    SCTID: 723067001

    Transcatheter aortic valve replacement (procedure)

        TAVI - transcatheter aortic valve implantation

        TAVR - transcatheter aortic valve replacement

        Transcatheter aortic valve replacement

    However, if this as you say is always done using fluoroscopic guidance, then it is duplicate to:

    Percutaneous replacement of aortic valve using fluoroscopic guidance (procedure)  

    SCTID: 441873006

    As to the Q about editorial policy, yes fluoroscopic guidance should be included in the FSN. Keeping in mind that the "Fully Specified Name (FSN) is intended to provide an unambiguous way to name a concept. The purpose of the FSN is to uniquely describe a concept and clarify its meaning. The FSN is not a commonly used term or natural phrase and would not be expected to appear in the human-readable representation of a clinical record."

    Further: "The preferred term is the preferred common word or phrase used by clinicians to name that concept in a particular language, dialect or context. Each concept has one or more descriptions of type synonym in each language. In each language or dialect one of these descriptions is marked as preferred and is the preferred term for that concept."

    My solution therefore is to not release the new concept but instead add as synonym Preferred Term to |Percutaneous replacement of aortic valve using fluoroscopic guidance (procedure)|

    Does that make sense to you?

    regards, Monica

     

    1. Monica Harry

      As this concept  SCTID: 723067001 | Transcatheter aortic valve replacement (procedure) | has not been released yet (and after discussion with the author who worked on the original request), it has been removed from the January 2017 release. A request for more information and clarification (as to whether this procedure is always fluoro or whether other imaging guidance methods are ever employed), has been sent to the submitter. Once we have a clear understanding of the request and the procedure and all possible modalities employed, then we will decided about best way forward re. FSNs, modelling etc. 

      thank you 

       

      Monica 

       

  2. Ray Simkus

    Hi Monica,

     

    I discussed this with one of the local expert heart surgeons. He told me that all of the transcatheter and percutaneous procedures are done with  fluoroscopic guidance. He also said that `having `fluoroscopic guidance` as part of the name would be redundant.

     

    Ray

    1. Monica Harry

      Great to have confirmation of this which is what I would expect. thanks, Monica