Department of Cardiac Surgery, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
J Thorac Cardiovasc Surg. 2011 Nov;142(5):1229-35. doi: 10.1016/j.jtcvs.2011.04.026.
Transcatheter aortic valve implantation is an emerging technique for the treatment of aortic valve stenosis in high-risk patients. Detailed knowledge of aortic root anatomy, including specific information on the extent of native cusp calcifications, is required. The aim of this study was to evaluate whether echocardiographic assessment of aortic stenosis using a calcification score is useful to predict outcomes of transcatheter aortic valve implantation in elderly high-risk patients.
Detailed preoperative digitalized transesophageal echocardiographic images were available from 103 patients treated by transapical transcatheter aortic valve implantation between February 2006 and February 2009. On the basis of a previously published study, an index score was developed to describe the extent of valve calcification ranging from 0 to 8 (normal to diffuse calcification).
The median age of patients was 82.2 ± 5.9 years. The mean logistic European System for Cardiac Operative Risk Evaluation was 33.0% ± 16.3%. Mild paravalvular leak was present in 43 patients (42.2%), and a moderate paravalvular leak was observed in 5 patients (4.9%). Severe regurgitation was not observed in any patient. Logistic regression analysis revealed that the transcatheter aortic valve implantation echocardiographic calcification score is associated with the presence of moderate paravalvular aortic regurgitation (odds ratio, 8.5; 95% confidence interval, 1.2-58.9; P = .0001) and overall moderate aortic regurgitation (odds ratio, 3.6; 95% confidence interval, 1.2-10.4; P = .0006).
Transesophageal echocardiography demonstrates detailed anatomic information of the calcification patterns of the aortic valve and root and thus plays an important role in the screening of patients undergoing transcatheter aortic valve implantation. The transcatheter aortic valve implantation echocardiographic calcification score allowed prediction of the risk of postoperative paravalvular and overall aortic regurgitation.
经导管主动脉瓣植入术是一种治疗高危患者主动脉瓣狭窄的新兴技术。需要详细了解主动脉根部解剖结构，包括对固有瓣叶钙化程度的具体信息。本研究旨在评估使用钙化评分评估主动脉瓣狭窄的经胸超声心动图评估是否有助于预测高龄高危患者经导管主动脉瓣植入术的结果。
2006 年 2 月至 2009 年 2 月期间，经心尖途径进行经导管主动脉瓣植入术治疗的 103 例患者提供了详细的术前数字化经食管超声心动图图像。根据之前的一项研究，开发了一种指数评分来描述瓣膜钙化程度，范围从 0 到 8（正常至弥漫性钙化）。
患者的中位年龄为 82.2 ± 5.9 岁。平均逻辑欧洲心脏手术风险评估系统为 33.0% ± 16.3%。43 例患者（42.2%）存在轻度瓣周漏，5 例患者（4.9%）存在中度瓣周漏。没有观察到任何患者有严重的反流。逻辑回归分析显示，经导管主动脉瓣植入术超声心动图钙化评分与中度瓣周主动脉反流的存在相关（比值比，8.5；95%置信区间，1.2-58.9；P =.0001）和总体中度主动脉反流（比值比，3.6；95%置信区间，1.2-10.4；P =.0006）。
经食管超声心动图显示了主动脉瓣和根部钙化模式的详细解剖信息，因此在经导管主动脉瓣植入术患者的筛选中发挥着重要作用。经导管主动脉瓣植入术超声心动图钙化评分可预测术后瓣周和总体主动脉反流的风险。
