Emini Ramiz, Gaisendrees Christopher, Kreft Marie, Liebold Andreas, Bauernschmitt Robert, Merkle-Storms Julia
Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Germany.
Department of Cardiothoracic and Vascular Surgery, University of Ulm, Germany.
Perfusion. 2025 Apr;40(3):613-620. doi: 10.1177/02676591241248537. Epub 2024 May 2.
AimsAdequate differentiation of calcifications in contrast-enhanced CT scans remains difficult to assess TAVI parameters. The size of the aortic leaflets has not been taken into account so far in present studies. The aim of our study was to establish a new method for optimized quantification of the aortic valve calcification degree in contrast-enhanced CT scans for better preoperative prediction of postoperative paravalvular leak after TAVI.Methods and resultsWe retrospectively analyzed preoperative contrast-enhanced CT scans of patients who underwent TAVI in our institution between 2014 and 2017. Calcium volume was quantified by a method using contrast enhanced computer tomography (3mensio-Structural Heart-7.2 software) with different iodine contents for better discrimination of contrast agent from calcium and by an individually set Houndsfield Unit (HU) threshold with 50HU above the individually determined reference value. Calcium volume was correlated with surface area of each aortic cusp. Perioperative variables were analyzed. All patients ( = 150) with severe aortic stenosis were treated with TAVI implantation. Overall incidence of postoperative trace to moderate PVL was 37%. The amount of calcium correlated with the incidence of PVL. In a logistic regression analysis total volume of calcification ( = .032) as well as calcification of each aortic cusp (NC_ = .001; RC_ < .001; LC_ = .001) were independent predictors.ConclusionsCalcification degree as well as its correlation with the surface area of each aortic cusp significantly influence incidence of PVL. Our new method improves preoperative quantification of the calcification degree by use of contrast agents with different iodine contents and thereby helps to improve patients' outcomes.
目的
在对比增强CT扫描中，钙化的充分区分对于评估经导管主动脉瓣植入术（TAVI）参数仍然难以实现。目前的研究中尚未考虑主动脉瓣叶的大小。我们研究的目的是建立一种新方法，用于在对比增强CT扫描中优化定量主动脉瓣钙化程度，以更好地术前预测TAVI术后瓣周漏。
方法和结果
我们回顾性分析了2014年至2017年在我们机构接受TAVI的患者的术前对比增强CT扫描。通过使用具有不同碘含量的对比增强计算机断层扫描（3mensio - 结构性心脏 - 7.2软件）的方法来量化钙体积，以便更好地区分造影剂和钙，并通过在个体确定的参考值之上设置50HU的单独Hounsfield单位（HU）阈值。钙体积与每个主动脉瓣叶的表面积相关。分析围手术期变量。所有150例严重主动脉瓣狭窄患者均接受TAVI植入治疗。术后微量至中度瓣周漏的总体发生率为37％。钙含量与瓣周漏的发生率相关。在逻辑回归分析中，钙化总体积（P = 0.032）以及每个主动脉瓣叶的钙化（无冠瓣P = 0.001；右冠瓣P <0.001；左冠瓣P = 0.001）是独立预测因素。
结论
钙化程度及其与每个主动脉瓣叶表面积的相关性显著影响瓣周漏的发生率。我们的新方法通过使用具有不同碘含量的造影剂改善了术前钙化程度的定量，从而有助于改善患者的预后。
