Interventional procedure overview of transcatheter aortic valve implantation for native aortic valve regurgitation
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Clinical assessment tools
Clinical assessment of severity of AR:
EuroSCORE II is a scoring system that measures risk of death for patients considering surgery. The score is calculated by taking into account factors related to the patient, the patient's heart condition and the proposed operation. It is expressed as a percentage and on a scale of 0 to 100% (higher scores indicating greater risk; a score higher than 20% indicates very high surgical risk).
The STS-PROM score distinguishes high and low-risk surgical patients and predicts postoperative outcome after the procedure.
NYHA heart failure classification is used to classify the severity of breathlessness; from class I, in which the patient has no limitation in daily physical activity, to class IV, in which the patient is breathless at rest.
Haemodynamic assessment (usually by echocardiography): severe chronic AR is considered to be present if one or more of the following findings are present on echocardiography. These include
central jet width 65% or more of LV outflow tract
vena contracta width more than 6 mm
holodiastolic flow reversal in the abdominal aorta
regurgitant fraction 50% or more
regurgitant volume of more than 60ml/beat and
an effective regurgitant orifice area 0.30 cm2 or more.
Studies using quantitative CMR has shown that significant LV remodelling or symptoms requiring aortic valve replacement may occur at lower thresholds of regurgitant volume (approximately 50 ml) and regurgitant fraction (approximately 40%). Hence, the severity assessment should include LV remodelling and symptoms with one of the above findings on echocardiography.
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