Abdelrahman Amr, Bamford Paul, Aktaa Suleman, Hall Rowan, Arockiam Sacchin, Blackman Daniel J, Malkin Christopher, Cunnington Michael, Ali Noman
Department of Cardiology, Leeds General Infirmary, Leeds, UK.
The University of Newcastle, Callaghan, New South Wales, Australia.
Open Heart. 2025 Jan 4;12(1):e002804. doi: 10.1136/openhrt-2024-002804.
Increasing demand for transcatheter aortic valve implantation (TAVI) places greater emphasis on the efficiency of pathways and services. A significant limitation to increasing TAVI capacity is the availability of cardiac catheterisation laboratory time. We have developed a novel complexity scoring system (TAVI ComplEXity; TEX score) which can aid in planning lists with appropriate case selection. To validate the TEX score, we have undertaken a retrospective analysis of TAVI cases. The hypothesis is that increasing TEX score correlates with increased procedural duration and reduced valve academic research consortium (VARC) 3 technical and device success.
The TEX score assigns patients to a complexity level of 1 (low), 2 (intermediate) or 3 (high) based on the presence of specific clinical and anatomical variables. For validation purposes, comparisons were made between patients in the three complexity levels with respect to procedural duration as well as VARC-3 technical success, device success and early safety.
The validation study included 1034 consecutive patients who underwent TAVI between June 2021 and October 2023. Of these, 582 (56.3%) were classified as level 1 complexity, 377 (36.5%) level 2 and 75 (7.3%) level 3. Significant differences were observed between the three groups with respect to procedural duration (73.7 min vs 85.6 min vs 136 min; p<0.001), VARC-3 technical success (97.9% vs 96.6% vs 92%; p<0.05) and VARC-3 device success (96.2% vs 92.3% vs 86.6%; p<0.001).
The TEX score is a simple tool which allows stratification of patients into three levels of complexity. Increasing complexity levels correlate with increasing procedural duration and reduced VARC-3 technical and device success. This is potentially useful for scheduling patients onto appropriate lists.
经导管主动脉瓣植入术（TAVI）需求的不断增加，使得对手术流程和服务效率的重视程度更高。增加TAVI手术量的一个重大限制是心导管实验室时间的可用性。我们开发了一种新型的复杂性评分系统（TAVI复杂性；TEX评分），它有助于通过适当的病例选择来安排手术名单。为了验证TEX评分，我们对TAVI病例进行了回顾性分析。假设是TEX评分的增加与手术时间的延长以及瓣膜学术研究联盟（VARC）3技术成功率和器械成功率的降低相关。
TEX评分根据特定临床和解剖学变量的存在情况将患者分为1级（低）、2级（中）或3级（高）复杂性水平。为了验证，对三个复杂性水平的患者在手术时间以及VARC - 3技术成功率、器械成功率和早期安全性方面进行了比较。
验证研究包括2021年6月至2023年10月期间连续接受TAVI手术的1034例患者。其中，582例（56.3%）被归类为1级复杂性，377例（36.5%）为2级，75例（7.3%）为3级。三组在手术时间（73.7分钟对85.6分钟对136分钟；p<0.001）、VARC - 3技术成功率（97.9%对96.6%对92%；p<0.05）和VARC - 3器械成功率（96.2%对92.3%对86.6%；p<0.001）方面存在显著差异。
TEX评分是一种简单的工具，可将患者分为三个复杂性水平。复杂性水平的增加与手术时间的延长以及VARC - 3技术成功率和器械成功率的降低相关。这对于将患者安排到合适的手术名单上可能是有用的。
