Ranucci Marco, Guarracino Fabio, Castelvecchio Serenella, Baldassarri Rubia, Covello Remo Daniel, Landoni Giovanni
Department of Cardiothoracic Anesthesia and Intensive Care, IRCCS Policlinico S.Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy.
Interact Cardiovasc Thorac Surg. 2010 Aug;11(2):138-41. doi: 10.1510/icvts.2010.236141. Epub 2010 May 19.
Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement in very high-risk patients with severe aortic stenosis. The present multicenter, retrospective study investigates the accuracy and calibration properties of the EuroSCORE and the age, serum creatinine, and ejection fraction (ACEF) score in selecting a population of patients to be referred to TAVI. The study includes 1053 surgical and 211 transcatheter procedures. The operative mortality rate within the surgical group was 2%. The EuroSCORE and the ACEF score had similar levels of accuracy; the ACEF score was well calibrated and the EuroSCORE overestimated the mortality risk. The observed mortality rate within the transcatheter group was 10.4%. Cut-off values corresponding to a mortality rate of 10% were 26 for the logistic EuroSCORE and 2.5 for the ACEF score: both the EuroSCORE and the ACEF score may be used to refer patients to TAVI. However, they do not consider a number of 'extreme' risk conditions that may justify a transcatheter procedure even in absence of an overall elevated risk score. These risk conditions should be included in a specific risk model for referring patients for TAVI.
经导管主动脉瓣植入术（TAVI）是患有严重主动脉瓣狭窄的极高风险患者进行外科主动脉瓣置换术的替代方案。本多中心回顾性研究调查了欧洲心脏手术风险评估系统（EuroSCORE）以及年龄、血清肌酐和射血分数（ACEF）评分在选择适合接受TAVI治疗的患者群体时的准确性和校准特性。该研究纳入了1053例外科手术和211例经导管手术。外科手术组的手术死亡率为2%。EuroSCORE和ACEF评分的准确性水平相似；ACEF评分校准良好，而EuroSCORE高估了死亡风险。经导管手术组的观察到的死亡率为10.4%。逻辑EuroSCORE对应10%死亡率的临界值为26，ACEF评分的临界值为2.5：EuroSCORE和ACEF评分均可用于推荐患者接受TAVI。然而，它们没有考虑一些“极端”风险情况，即使在总体风险评分未升高的情况下，这些情况也可能成为经导管手术的理由。这些风险情况应纳入用于推荐患者接受TAVI的特定风险模型中。
