Abstract
Transcatheter aortic valve implantation (TAVI) provokes early injury response, represented in part by dynamic changes in the inflammatory markers. The association of self-expanding valves (SEVs) and balloon-expandable valves (BEVs) with the consequent inflammatory response remains uncertain. Patients with severe symptomatic aortic stenosis who underwent transfemoral TAVI: SEVs or BEVs, from January 2010 to December 2019 were enrolled. Whole white blood cells (WBC) and subpopulation dynamics as well the neutrophil to lymphocyte ratio (NLR) were evaluated. Three-hundred seventy consecutive patients (mean age 81.75 ± 6.8 years, 199 women's) were enrolled. In the entire population, significant kinetic changes in the WBC response (p <0.0001) between admission and first 24 hours post procedure, with a significant increase in total WBC (7.46 ± 2.26 to 10.08 ± 3.55) and absolute neutrophil count (4.97 ± 2.06 to 8.19 ± 3.43), NL ratio (3.72 ± 2.8 to 9.76 ± 7.29), and a meaningful decrease in absolute lymphocytes count (1.67 ± 1.1 to 1.1 ± 0.76). When compared between the types of valves, SEVs were associated with a more pronounced inflammatory response than BEVs, with total WBC (10.44 ± 3.86 vs. 9.45 ± 3.19) neutrophils (8.56 ± 3.75 vs. 7.55 ± 3.06) with p 0.016 and 0.012 respectively. This is the first description of a differential inflammatory response between the two leading delivery systems. SEV appears to trigger a more robust inflammatory response as compared to BEV. Clinical studies are warranted to assess the long term effect of our findings.
Highlights
This is the first description of a differential inflammatory response between the two leading delivery systems
Previous studies have reported that developing a systemic inflammatory response syndrome (SIRS) after transcatheter valve implantation (TAVI) is associated with poor prognosis [1,2,3,4,5,6,7]
There is no clinical data comparing the impact of self-expandable valves (SEV) and balloon-expandable valves (BEV), the two leading implantation systems on neutrophil to lymphocyte ratio (NLR)
Summary
Previous studies have reported that developing a systemic inflammatory response syndrome (SIRS) after transcatheter valve implantation (TAVI) is associated with poor prognosis [1,2,3,4,5,6,7]. The neutrophil to lymphocyte ratio (NLR) is a well described prognostic marker in cardiovascular medicine [8,9,10,11]. There is no clinical data comparing the impact of self-expandable valves (SEV) and balloon-expandable valves (BEV), the two leading implantation systems on NLR. As inflammation triggers a series of biological processes that could potentially promote the long term viability of the valves, it is important to study differences in the pro-inflammatory behavior of different valves and associate those with long term durability and outcome
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