Haensig Martin, Lehmkuhl Lukas, Linke Axel, Kiefer Philipp, Mukherjee Chirojit, Schuler Gerhard, Gutberlet Matthias, Mohr Friedrich-Wilhelm, Holzhey David
Department of Cardiac Surgery, Heart Center of the University of Leipzig, Leipzig, Germany.
Department of Interventional and Diagnostic Radiology, Heart Center of the University of Leipzig, Leipzig, Germany.
Heart Surg Forum. 2016 Feb 24;19(1):E36-42. doi: 10.1532/hsf.1399.
Transapical aortic valve implantation (TAAVI) has evolved into a routine procedure for select high-risk patients. The aim was to study the impact of native aortic valve calcification on paravalvular leaks in cardiac contrast-enhanced computed tomography (CT).
The degree and distribution of valve calcification were quantified using an Aortic Valve Calcium Score (AVCS) for each cusp separately (3mensio Valves). To reduce an artificial increase of the AVCS due to the presence of contrast material, we used thresholds for density [mean aortic density + 2*SD] and volume [0, 3, 5, 25, and 50 mm3] of calcification.
111 consecutive patients prior to TAAVI with preoperative CT aged 79.8 ± 5.8 years were included using the Edwards Sapien prosthesis. Paravalvular leaks were significantly associated with eccentric calcified plaques (r [Spearman] = 0.37; χ2-statistic = 15.4; P = .002), presence of LVOT calcium (r [Spearman] = 0.28; χ2-statistic = 11.3; P = .009), and the commissural gap at the anatomic ventriculo-arterial junction (r [Spearman] = 0.41-0.63; χ2-statistic = 50.8-53.0; P = .002-≤.001). There was no significant association between the total AVCS and PV leaks (r [Spearman] = 0.076; χ2-statistic = 1.471; P = .240, 120 kV, 850 hounsfield units) with no additional use of a volume-based threshold.
Asymmetry of leaflet calcium distribution, LVOT calcium, and the commissural gap between leaflets were significantly associated with paravalvular leaks. Moreover, quantification of aortic valve calcification in contrast enhanced CTs shows only a weak correlation with paravalvular leakage and is therefore not reliable as a predictor, respectively.
经心尖主动脉瓣植入术（TAAVI）已发展成为针对特定高危患者的常规手术。目的是研究在心脏对比增强计算机断层扫描（CT）中，天然主动脉瓣钙化对瓣周漏的影响。
使用主动脉瓣钙评分（AVCS）分别对每个瓣叶的钙化程度和分布进行量化（3mensio瓣膜）。为减少因造影剂存在导致的AVCS人为升高，我们使用了钙化密度[平均主动脉密度 + 2*标准差]和体积[0、3、5、25和50立方毫米]的阈值。
使用爱德华兹Sapien假体，纳入了111例连续的TAAVI术前CT检查的患者，年龄为79.8 ± 5.8岁。瓣周漏与偏心钙化斑块显著相关（r[斯皮尔曼] = 0.37；χ2统计量 = 15.4；P = 0.002）、左心室流出道钙化的存在（r[斯皮尔曼] = 0.28；χ2统计量 = 11.3；P = 0.009）以及解剖学心室-动脉交界处的瓣叶间隙（r[斯皮尔曼] = 0.41 - 0.63；χ2统计量 = 50.8 - 53.0；P = 0.002 - ≤0.001）。在未额外使用基于体积的阈值的情况下，总AVCS与瓣周漏之间无显著关联（r[斯皮尔曼] = 0.076；χ2统计量 = 1.471；P = 0.240，120 kV，850亨氏单位）。
瓣叶钙分布不对称、左心室流出道钙化以及瓣叶之间的瓣叶间隙与瓣周漏显著相关。此外，对比增强CT中主动脉瓣钙化的量化与瓣周漏仅显示出弱相关性，因此分别作为预测指标并不可靠。
