The Inflammatory Response to Transcatheter Aortic Valve Replacement

Area of Science:

• Cardiology
• Immunology
• Biomaterials

Background:

• Inflammation is a common response following transcatheter aortic valve replacement (TAVR).
• This response stems from endothelial damage, hypoperfusion, and immune reactions to the bioprosthesis.
• The inflammatory spectrum ranges from asymptomatic biomarker changes to severe clinical events.

Purpose of the Study:

• To review the epidemiology, pathophysiology, and consequences of inflammation post-TAVR.
• To discuss strategies for controlling hyperinflammation and identify patients who may benefit from inflammatory pathway modulation.

Main Methods:

• Literature review of studies on TAVR-associated inflammation.
• Analysis of inflammatory markers, cellular signatures, and clinical outcomes.
• Discussion of current and emerging therapeutic strategies.

Main Results:

• Hyperinflammation post-TAVR is linked to increased risks of conduction disturbances, atrial fibrillation, acute kidney injury, prolonged hospitalization, mortality, and subclinical leaflet thrombosis.
• Specific monocyte and T helper cell profiles correlate with poorer outcomes.
• Potential interventions include managing hypotension, periprocedural medications (colchicine, glucocorticoids), monoclonal antibodies, and microbiome health.

Conclusions:

• Understanding and managing the inflammatory response to TAVR is crucial for optimizing patient outcomes.
• Targeted strategies to mitigate hyperinflammation are needed.
• Further research into modulating inflammatory pathways may improve TAVR results.