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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Technical Approach Determines Inflammatory Response after Surgical and Transcatheter Aortic Valve Replacement
Gabor Erdoes1, Christoph Lippuner1,2, Istvan Kocsis3
1Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Plos One
|November 25, 2015
Summary
Transcatheter aortic valve implantation (TAVI) via transfemoral access shows the least inflammatory response compared to surgical aortic valve replacement (SAVR) and transapical TAVI. Different TAVI and SAVR techniques significantly modulate the periprocedural inflammatory response.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Immunology
Background:
- Aortic valve stenosis necessitates valve replacement, with surgical (SAVR) and transcatheter (TAVI) approaches offering different procedural invasiveness.
- Understanding the periprocedural inflammatory response is crucial for optimizing patient outcomes after aortic valve replacement.
Purpose of the Study:
- To compare the periprocedural inflammatory response in patients undergoing SAVR versus TAVI with varying technical approaches.
- To identify which aortic valve replacement technique elicits the most attenuated inflammatory profile.
Main Methods:
- Prospective study comparing SAVR (conventional or minimized extracorporeal circulation) and TAVI (transapical or transfemoral access).
- Inflammatory markers (IL-6, IL-8, IL-10, HLA-DR, hs-CRP, sCD62L, WBC) were measured pre-procedure and at 4, 24, and 48 hours post-procedure.
- Exclusion criteria included infection, pre-procedural immunosuppression, antibiotic use, and emergency procedures.
Main Results:
- SAVR with conventional extracorporeal circulation showed the highest levels of IL-8 and hs-CRP.
- Minimised extracorporeal circulation in SAVR led to the greatest reduction in HLA-DR and sCD62L.
- Transapical TAVI demonstrated the highest peak IL-6, while transfemoral TAVI exhibited significantly smaller inflammatory marker changes.
Conclusions:
- The invasiveness of aortic valve replacement significantly influences the periprocedural inflammatory response.
- Transfemoral TAVI is associated with the most attenuated inflammatory response, while extracorporeal circulation in SAVR induces the most pro-inflammatory activation.
- Transapical TAVI's inflammatory profile resembles SAVR, classifying it as a surgical procedure; no direct link between inflammation and clinical outcomes was established.
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