Case Observation Questionaire
Field Team: We are working to put together a comprehensive resource for our TAVR Customer Education offerings. I am gathering information on our current case observation sites for use in this resource. You are identified as having field responsibilities for a current case observation site, and we would like your help in gathering the information below. Your colleagues in the field will use this resource to talk to their customers about these programs, so please take the time to give detailed and accurate answers. We appreciate your help!
Your information
Please provide your contact information in case we have questions.
Form completed by:
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First Name
Last Name
Email
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example@example.com
Phone Number
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-
Area Code
Phone Number
Case Observation Overview
Hospital Name
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What type of hospital setting?
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University
Teaching site
Community site
Private hospital
How would you best describe the implanting style at this site? (select all that apply)
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Fast and furious
Outside the box
Methodical - best practices
Other
What does this site pride themselves on or specialize in with the TAVR procedure?
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Back
Next
Case Planning
What day(s) of the week does this site do TAVR implants? (check all that apply)
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Monday
Tuesday
Wednesday
Thursday
Friday
Is there a formal valve conference that is included as part of the observation day?
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Yes
No
Who leads the valve conference?
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Physician led
VCC led
Team approach
Who is involved in the conference?
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Full Heart team (IC, Surgeon, VCC, Cath Lab Staff)
Partial Heart team
Are imaging physicians/staff involved in valve conference?
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Yes
No
Sometimes
Are Medtronic employees welcome to attend the valve conference?
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Yes
No
Are Medtronic employees allowed to present information or recommendations?
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Yes
No
Who makes the final device decision?
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Singular IC
Surgeon
VCC
Heart team
Pre-procedural
When does the patient arrive?
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Day of procedure
Night before procedure
Varies
How long does is usually take for entire patient prep?
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< 30 mins
30 - 60 mins
> 60 mins
Where are the procedures performed?
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Cath lab
Operating room
Hybrid OR
Where are patient lines put in?
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Pre-op room
Cath lab
Operating room
Hybrid OR
What lines are used? (Check all that apply)
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IJ
Radial
Foley
Swan Ganz
Who puts in lines? (Check all that apply)
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Anesthsiologist
CRNA
Nurse
Other
How long does is usually take to put in lines?
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< 30 mins
30 - 60 mins
> 60 mins
Back
Next
Intra-procedural
Staffing model per case (enter the # of each during the case, enter 0 for none)
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# of people per case
Interventional Cardiologist
Surgeon
Fellow
Cardiac Anesthesiologist
CRNA
Echocardiologist/Echo tech
Cath lab/OR nurse
Circulating nurse
Perfusionist
Cath Lab tech
OR tech
Control room
PA
Does the site use staff in creative ways/cross-functionality?
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Yes
No
If yes, how?
Select one:
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Staff writes down or posts measurements and angio angle in room
Site relies on Medtronic rep for the information
Who loads the valve? (Check all that apply)
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Medtronic rep
Cath lab staff
OR nurse or tech
Perfusionist
Does the site rely on MDT rep for intra-procedural recommendations?
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Always
Sometimes
Never
Who makes intra-procedural decisions?
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Singular IC
Surgeon
Heart team
Access & Operators
Who gains vessel access? (Check all that apply)
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Fellow
IC
Surgeon
Other
Do they excel at vessel access?
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Yes
No
Average
What do they prefer to use?
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In-line sheath
External sheath
Depends
Who crosses the valve? (Check all that apply)
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Fellow
IC
Surgeon
Other
Do they excel at crossing the valve?
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Yes
No
Average
Who typically stands in Operator 1 and Operator 2 positions?
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Operator 1
Operator 2
Interventional Cardiologist
Surgeon
Fellow
Who does wire control?
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Wire Control
Interventional Cardiologist
Surgeon
Fellow
Nurse
Tech IC
PA
Anesthesia & Imaging
What does the site typically use?
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General Anesthesia
Conscious Sedation
MAC
If CS or MAC, is the patient ______________ during the procedure:
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Talking
Moving
Sleeping
Which is used intra-procedure?
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TEE
TTE
ICE
Imager is:
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Anesthesiologist
Echocardiologist
Echo tech
Is the Imager proficient at views and interpretation?
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Yes
No
Does the Imager have a say in the intra-operative decisions?
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Yes
No
Please respond to each question in the table below:
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Always
Sometimes
Rarely
Never
Does the Imager perform 3_D Ao annulus measurements?
Does the Imager perform 3-D Ao root measurements?
Does the site use echo at 2/3rds to assess device depth/PVL?
Does the site use angio at 2/3rds to assess device depth/PVL?
Does the site purposely limit fluro time/contrast during the procedure?
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Yes
No
Back
Next
Deployment & Post-deployment
Does the site pre-BAV?
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Always
Sometimes
Never
Pre-BAV is ________________?
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Size 18 or 20mm
From annulus minimum diameter
Other
Does the site post-BAV?
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Always
Sometimes
Never
Post-BAV is sized on ___________?
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mean annulus diameter
inside calcium measurement
Other
Does the site pace during deployment?
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Always
Sometimes
Never
If they pace, what is the rate?
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Does the site use echo to assess device post-deployment?
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Always
Sometimes
Never
What are they assessing?
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Depth
PVL
Both
Does the site use angio to assess device post-deployment?
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Always
Sometimes
Never
What are they assessing?
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Depth
PVL
Both
Does the site use cath hemo's to assess device post-deployment?
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Always
Sometimes
Never
Are they assessing:
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Gradients
PVL
Both
Other
Does the site have ____________ PPM rates post-TAVR?
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High
Moderate
Low
The site usually implants __________ depth?
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Low
Correct
High
The site will accept _______ PVL post deployment without further intervention?
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Trace
Mild
Moderate or >
Does the site wait 10 minutes to see if PVL reduces?
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Yes
No
Sometimes
Will the site usually post-BAV if PVL is ______:
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Trace
Mild
Moderate or >
Back
Next
Post Procedural
As a general rule, the temporary pacer is:
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left in the groin
left in the IJ
moved to IJ
removed
As a general rule, the patient is transferred to:
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PACU
ICU
telemetry floor
Cath lab/OR turnaround time
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hours
Average number of cases per day
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Device Selection
The site implants Evolut _____ of TAVR cases.
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< 50%
50%
> 50%
Evolut cases per year
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Preferences for using Evolut:
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Site prefers to use Evolut for:
Site generally will NOT use Evolut for:
N/A
Heavily calcified annulus
Heavily calcified LVOT
Heavily calcified leaflets
Tri-leaflet with Raphe AV
Bicuspid AV (two leaflet)
Low EF
Absence of calcified annulus
Absence of calcified leaflets
Small aortic root
Stented ViV
Stentless ViV
Recent PCI or needs PCI
Subclavian access
Direct aortic access
Small access
Miscellaneous
The site has _____ TAVR teams.
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One
Multiple
If multiple, how many?
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CT Software
CT Machine
Echo Machine
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