Loomba Rohit S, Pelech Andrew N
Division of Cardiology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA.
Division of Cardiology, UC-Davis Children's Hospital, Sacramento, California, USA.
Congenit Heart Dis. 2018 Jan;13(1):92-97. doi: 10.1111/chd.12510. Epub 2017 Jun 27.
Pulmonary atresia with intact ventricular septum is a unique congenital malformation of the heart in which patients may undergo single-, two- or 1½- ventricle repair. Size of the tricuspid valve annulus, morphology of the right ventricle and presence of ventriculocoronary connections can all impact the selection of appropriate palliative strategy. We developed the aortic perfusion score, a novel scoring system based on anterograde coronary perfusion with the aim of being able to identify patients at risk for death or transplant.
A retrospective study was conducted. Patients were included if an initial catheterization was done prior to any intervention. Each patient was assigned an aortic perfusion score based on the amount of antegrade perfusion to the four main coronary arteries. Various characteristics, including aortic perfusion score, were compared between those who required transplant or died during follow-up vs those who did not. Receiver operator curve analysis was done to determine a cutoff point predictive of a composite endpoint of death or transplant.
A total of 64 patients were included in the analysis with 10 reaching the composite outcome. An aortic perfusion score of 227.5 predicted the endpoint with a sensitivity of 90% and a specificity of 83%. For each 1-point increase in the APS, the odds of death or transplant decreased by 1.7%.
The aortic perfusion score can be used to predict a composite endpoint of death or transplant and may be helpful in selecting patients that should be listed for transplant.
室间隔完整的肺动脉闭锁是一种独特的先天性心脏畸形，此类患者可能接受单心室、双心室或1.5心室修复。三尖瓣环大小、右心室形态以及心室冠状动脉连接情况均会影响合适姑息治疗策略的选择。我们开发了主动脉灌注评分，这是一种基于顺行性冠状动脉灌注的新型评分系统，旨在能够识别有死亡或移植风险的患者。
进行了一项回顾性研究。纳入在任何干预之前进行过首次心导管检查的患者。根据四条主要冠状动脉的顺行性灌注量为每位患者分配一个主动脉灌注评分。比较随访期间需要移植或死亡的患者与未出现此类情况的患者之间的各种特征，包括主动脉灌注评分。进行受试者操作特征曲线分析以确定预测死亡或移植复合终点的临界点。
共有64例患者纳入分析，其中10例达到复合结局。主动脉灌注评分为227.5时预测该终点的灵敏度为90%，特异度为83%。主动脉灌注评分每增加1分，死亡或移植的几率降低1.7%。
主动脉灌注评分可用于预测死亡或移植的复合终点，可能有助于选择应列入移植名单的患者。
