Evaluation of systemic inflammation in response to remote ischemic preconditioning in patients undergoing transcatheter aortic valve replacement (TAVR)

Axel Linke,Christian Pfluecke,Dieter Fedders,Felix M Heidrich,Karim Ibrahim,Krunoslav M Sveric,Kun Zhang,Matthias Kuhn,Robert Winzer,Ruth H Strasser,Silvio Quick,Stephan Wiedemann,Tobias F Ruf,Willi Troeger

doi:10.31083/j.rcm2301020

Abstract

Systemic inflammation can occur after transcatheter aortic valve replacement (TAVR) and correlates with adverse outcome. The impact of remote ischemic preconditioning (RIPC) on TAVR associated systemic inflammation is unknown and was focus of this study. We performed a prospective controlled trial at a single center and included 66 patients treated with remote ischemic preconditioning (RIPC) prior to TAVR, who were matched to a control group by propensity score. RIPC was applied to the upper extremity using a conventional tourniquet. Definition of systemic inflammation was based on leucocyte count, C-reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6), assessed in the first 5 days following the TAVR procedure. Mortality was determined within 6 months after TAVR. RIPC group and matched control group showed comparable baseline characteristics. Systemic inflammation occurred in 66% of all patients after TAVR. Overall, survival after 6 months was significantly reduced in patients with systemic inflammation. RIPC, in comparison to control, did not significantly alter the plasma levels of leucocyte count, CRP, PCT or IL-6 within the first 5 days after TAVR. Furthermore, inflammation associated survival after 6 months was not improved by RIPC. Of all peri-interventional variables assessed, only the amount of the applied contrast agent was connected to the occurrence of systemic inflammation. Systemic inflammation frequently occurs after TAVR and leads to increased mortality after 6 months. RIPC neither reduces the incidence of systemic inflammation nor improves inflammation associated patient survival within 6 months.

Highlights

Transcatheter aortic valve replacement (TAVR) was first successfully performed in 2002 in a critically ill patient with severe aortic stenosis [1]
Based on common denominators of systemic inflammation, i.e., leucocyte count, C-reactive protein (CRP), PCT and IL-6, we estimated the incidence of inflammatory response after transcatheter aortic valve replacement (TAVR)
The occurrence of a systemic inflammatory response after TAVR has been the focus of investigation in only a few studies and it has been associated with inferior outcomes [4,5,15]

Summary

Introduction

Transcatheter aortic valve replacement (TAVR) was first successfully performed in 2002 in a critically ill patient with severe aortic stenosis [1]. Systemic inflammatory response syndrome (SIRS) occurs in approximately 50% of patients after the TAVR procedure [3] and is associated with increased morbidity and mortality [4,5]. Systemic inflammation can occur after transcatheter aortic valve replacement (TAVR) and correlates with adverse outcome. Definition of systemic inflammation was based on leucocyte count, C-reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6), assessed in the first 5 days following the TAVR procedure. RIPC, in comparison to control, did not significantly alter the plasma levels of leucocyte count, CRP, PCT or IL-6 within the first 5 days after TAVR. Conclusions: Systemic inflammation frequently occurs after TAVR and leads to increased mortality after 6 months. RIPC neither reduces the incidence of systemic inflammation nor improves inflammation associated patient survival within 6 months

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