Department of Cardiology/Angiology, HELIOS Heart Center Siegburg, Siegburg, Germany.
JACC Cardiovasc Interv. 2010 Feb;3(2):233-43. doi: 10.1016/j.jcin.2009.11.015.
The aim of this study was to assess the influence of amount and distribution of calcifications of the aortic valve and the left ventricular outflow tract on the acute procedural outcome of patients undergoing transcatheter aortic valve implantation (TAVI).
Transcatheter aortic valve implantation is a new percutaneous technique especially for elderly, high-risk patients with significant aortic valve stenosis (AS). After TAVI, post-interventional paravalvular aortic regurgitations (PAR) can occur, which is believed to be related partially to valve calcifications.
We prospectively analyzed 100 symptomatic patients with severe AS scheduled for TAVI with the CoreValve ReValving (Medtronic, Minneapolis, Minnesota) prosthesis. In all patients, a native and contrast-enhanced multislice cardiac computed tomography was performed pre-interventionally. Calcification load of the valve and the adjacent outflow tract was estimated by the Agatston Score (AgS), and the amount and distribution of calcification was semi-quantitatively assessed and graded on a 1 to 4 scale (device "landing zone" calcification score [DLZ-CS]). Aortography was performed to evaluate the PAR pre-interventionally, after initial device release (PAR0) and after termination of the procedure (PAR1). Transthoracic echocardiography was performed 2 weeks after implantation (PAR2).
The AgS and DLZ-CS showed a significant correlation with the grade of PAR0 (AgS: r = 0.329, p = 0.001; DLZ-CS: r = 0.356, p < 0.001), PAR1 (AgS: r = 0.254, p = 0.011; DLZ-CS: r = 0.240, p = 0.016), and PAR2 (AgS: r = 0.341, p = 0.001; DLZ-CS: r = 0.300, p = 0.002). Both scores (AgS and DLZ-CS) showed a significant positive correlation (r = 0.858, p < 0.001).
Calcification in the CoreValve device "landing zone" shows a significant positive correlation to PAR after TAVI. Furthermore, the need for "second maneuvers" (i.e., post-dilation after initial device release) can be predicted by these calcification scores (AgS and DLZ-CS).
本研究旨在评估主动脉瓣和左心室流出道钙化的数量和分布对行经导管主动脉瓣植入术（TAVI）患者急性手术结果的影响。
经导管主动脉瓣植入术是一种新的经皮技术，特别适用于有严重主动脉瓣狭窄（AS）的老年高危患者。TAVI 后，可能会发生介入后瓣周主动脉瓣反流（PAR），据信这部分与瓣膜钙化有关。
我们前瞻性分析了 100 例因严重 AS 接受 CoreValve ReValving（美敦力，明尼苏达州明尼阿波利斯）瓣膜植入术的症状性患者。所有患者均在术前进行了原生和对比增强多层心脏计算机断层扫描。通过 Agatston 评分（AgS）评估瓣膜和相邻流出道的钙化负荷，并通过 1 到 4 级半定量评估钙化的数量和分布（器械“着陆区”钙化评分[DLZ-CS]）。主动脉造影术用于术前评估 PAR，初始器械释放后（PAR0）和手术结束后（PAR1）。植入后 2 周进行经胸超声心动图检查（PAR2）。
AgS 和 DLZ-CS 与 PAR0 分级呈显著相关性（AgS：r = 0.329，p = 0.001；DLZ-CS：r = 0.356，p < 0.001）、PAR1（AgS：r = 0.254，p = 0.011；DLZ-CS：r = 0.240，p = 0.016）和 PAR2（AgS：r = 0.341，p = 0.001；DLZ-CS：r = 0.300，p = 0.002）。这两个评分（AgS 和 DLZ-CS）之间呈显著正相关（r = 0.858，p < 0.001）。
CoreValve 器械“着陆区”内的钙化与 TAVI 后 PAR 呈显著正相关。此外，这些钙化评分（AgS 和 DLZ-CS）可预测“二次操作”（即初始器械释放后扩张）的需求。
