Transcatheter Aortic Valve Replacement Is Associated with Less Oxidative Stress and Faster Recovery of Antioxidant Capacity than Surgical Aortic Valve Replacement.

Anna Komosa,Mateusz Puślecki,Barbara Poniedziałek,Tatiana Mularek-Kubzdela,Zbigniew Krasiński,Piotr Rzymski,Maciej Lesiak,Mariola Ropacka-Lesiak,Bartłomiej Perek,Marek Grygier,Anna Olasińska-Wiśniewska,Marcin Misterski,Jolanta M Siller-Matula,Przemysław Niedzielski

doi:10.3390/jcm8091364

Abstract

The objective of this study was to compare oxidative stress indices in 24 patients (mean ± SD age 71 ± 13 years) undergoing surgical aortic valve replacement (SAVR) versus transcatheter aortic valve replacement (TAVR). Serum total antioxidant capacity (TAC), copper/zinc ratio (Cu/Zn), activity of lactate dehydrogenase (LDH), and thiobarbituric acid reactive substances (TBARS) were assessed at four different time-points: pre-procedure, immediately post-procedure, and one day and two days after the procedure. All oxidative stress parameters were comparable in both groups pre-procedure. TAC decreased significantly when assessed immediately after procedures in both groups (p < 0.001); however, the magnitude of the reduction was more pronounced after SAVR (88% decrease from baseline: 1.8 ± 0.1 vs. 0.2 ± 0.03 mM) compared to TAVR procedures (53% decrease from baseline: 1.9 ± 0.1 vs. 1.0 ± 0.1 mM; p < 0.001). TAC returned to baseline two days after TAVR in all patients, but was still reduced by 55% two days after SAVR. In concordance, TBARS levels and Cu/Zn ratio increased significantly with maximum levels immediately after procedures in both groups (p < 0.001), but the magnitude of the increase was significantly higher in SAVR compared to TAVR (TBARS: 3.93 ± 0.61 µM vs. 1.25 ± 0.30 µM, p = 0.015; Cu/Zn ratio: 2.33 ± 0.11 vs. 1.80 ± 0.12; p < 0.001). Two days after the procedure, TBARS levels and the Cu/Zn ratio returned to baseline after TAVR, with no full recovery after SAVR. TAVR is associated with a lesser redox imbalance and faster recovery of antioxidant capacity compared to SAVR.

Highlights

Aging of societies, prolonged expected life span, and substantial progress in medicine in developed countries has resulted in the predominance of degenerative aortic stenosis (AS) among cardiac valvular pathologies requiring invasive treatment [1,2]
As the comparative data concerning the oxidative stress between both procedures is limited, the aim of our study was to compare serum oxidative stress indices in patients undergoing surgical aortic valve replacement (SAVR) vs. transcatheter aortic valve replacement (TAVR) procedures during the hospital stay
total antioxidant capacity (TAC) decreased significantly when assessed immediately after procedures in both groups (p < 0.001), TAC reduction was less pronounced in TAVR as compared to SAVR (1.71 ± 0.34 vs. 0.14 ± 0.16 mM) (Figure 1)

Summary

Introduction

Aging of societies, prolonged expected life span, and substantial progress in medicine in developed countries has resulted in the predominance of degenerative aortic stenosis (AS) among cardiac valvular pathologies requiring invasive treatment [1,2]. Surgical aortic valve replacement (SAVR) with the use of cardio-pulmonary bypass (CBP) remains the standard of severe AS treatment, at present, elderly and intermediate to high-risk patients undergo minimally invasive transcatheter aortic valve replacement (TAVR) with a trend toward low-risk populations [3,4,5]. In the last few years, the expectations of patients undergoing invasive cardiac procedures, including aortic valve surgery have been markedly increased. TAVR procedures as a minimally invasive option appear to be safer compared to SAVR [4]. One can expect that a choice of therapy for symptomatic severe aortic stenosis may have an impact on the magnitude of post-surgical oxidative stress and eventually on early and late outcomes. There are several factors that may predict unfavorable outcomes and postoperative adverse events

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