Technical Approach Determines Inflammatory Response after Surgical and Transcatheter Aortic Valve Replacement
Key result
Transfemoral transcatheter aortic valve implantation resulted in the most attenuated inflammatory response, whereas surgical aortic valve replacement with conventional extracorporeal circulation was associated with the highest levels of IL-8 (p<0.017) and hs-CRP (p=0.007).
Why the study?
Does the technical approach (SAVR vs TAVI) affect the periprocedural inflammatory response in patients with isolated aortic valve stenosis?
Population
101 patients with isolated aortic valve stenosis. Exclusions: infection, pre-procedural immunosuppressive or…
Comparison
Transcatheter aortic valve implantation via… vs Surgical aortic valve replacement using…
Design
Cohort
Follow-up
48 hours
Authors
Discussion
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Member takes
Implication
May support transfemoral TAVI to limit inflammation in select patients; leaves open outcome impact pending RCTs.
Study Design
Type
Cohort (n=101)
Multicenter
No
Structured PICO
Does the technical approach (SAVR vs TAVI) affect the periprocedural inflammatory response in patients with isolated aortic valve stenosis?
P
Population
101 patients with symptomatic severe aortic stenosis who underwent surgical or transcatheter aortic valve replacement, followed for 48 hours to assess periprocedural inflammatory responses.
E
Exposure
Transcatheter aortic valve implantation (TAVI) via transapical (n=15) or transfemoral (n=24) access, or surgical aortic valve replacement (SAVR) using minimized extracorporeal circulation (n=15)
C
Comparator
Surgical aortic valve replacement (SAVR) using conventional extracorporeal circulation (n=47)
O
Outcome
Levels of IL-6, IL-8, IL-10, HLA-DR, white blood cell count, hs-CRP, and sCD62L before the procedure and at 4, 24, and 48 hours after aortic valve replacementsurrogate
Transfemoral TAVI is associated with a significantly attenuated periprocedural inflammatory response compared to transapical TAVI and surgical aortic valve replacement.
Limitations
- Small sample size per group
- Lack of randomization
- Single-center design
- Inflammatory response measured only via circulating biomarker levels, not gene expression in organ biopsies
- Heterogeneous patient comorbidities and concurrent medications with heterogeneous effects on the inflammatory response
- Could not establish an obvious link between the extent of the periprocedural inflammatory response and clinical outcome parameters
Cite This Study
Erdoes et al. (2015) conducted a cohort in Symptomatic severe aortic stenosis (n=101). Aortic valve replacement techniques (SAVR with CECC or MECC, TA-TAVI, TF-TAVI) vs. Compared among techniques was evaluated on Periprocedural inflammatory response (IL-6, IL-8, IL-10, HLA-DR, WBC, hs-CRP, sCD62L). Transfemoral transcatheter aortic valve implantation resulted in the most attenuated inflammatory response, whereas surgical aortic valve replacement with conventional extracorporeal circulation was associated with the highest levels of IL-8 (p<0.017) and hs-CRP (p=0.007).