title: Inflammatory response in transapical transaortic valve replacement.
abstract: OBJECTIVE
  Transapical aortic valve implantation (TA-AVI) has become a fast growing alternative to conventional aortic valve replacement (cAVR) particularly for patients burdened with serious comorbidities. We investigated whether the inflammatory response triggered by TA-AVI reflects the less invasive nature of this procedure.
  
  
  METHODS
  In this prospective observational study 25 patients undergoing aortic valve replacement (AVR; 15 cAVR and 10 TA-AVI) were included. Serial plasma cytokine concentrations (IL-6, IL-8, and IL-10) were measured by commercially available enzyme-linked immunosorbent assay kits at six different time points before, during, and after surgery.
  
  
  RESULTS
  Plasma levels of all three cytokines increased during and after both procedures and returned to baseline before the patient's discharge. Peak values of IL-6 were 258 ± 113 pg/mL in AVR patients versus 111 ± 101 pg/mL in TA-AVI patients and were reached 12 hours after surgery. For IL-8, peak values were 51 ± 29 pg/mL 1 hour after surgery in AVR patients versus 15 ± 20 pg/mL on wound closure in TA-AVI patients. Plasma levels of IL-6 and IL-8 were significantly reduced in the TA-AVI group as compared with cAVR. IL-10 is markedly activated in both groups yet its induction is more prominent in AVR patients with peak values of 51 ± 28 pg/mL for AVR versus 24 ± 18 pg/mL for TA-AVI on wound closure.
  
  
  CONCLUSIONS
  TA-AVI compared with cAVR results in a significant reduction but not elimination of a systemic inflammatory response, which is attributable to cardiopulmonary bypass-dependent and bypass-independent factors.
authors.affiliation: Department of Anesthesiology, University Clinic RWTH Aachen, Aachen, Germany. agoetzenich@ukaachen.de
authors.forename: A
authors.initials: A
authors.lastname: Goetzenich
authors.forename: A
authors.initials: A
authors.lastname: Roehl
authors.forename: J
authors.initials: J
authors.lastname: Spillner
authors.forename: M
authors.initials: M
authors.lastname: Haushofer
authors.forename: G
authors.initials: G
authors.lastname: Dohmen
authors.forename: L
authors.initials: L
authors.lastname: Tewarie
authors.forename: A
authors.initials: A
authors.lastname: Moza
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D002404:Catheterization / Q000379:methods; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000209:etiology; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007378:Interleukins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011446:Prospective Studies; D011474:Prosthesis Design; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D016209:Interleukin-8; D007378:Interleukins; D016753:Interleukin-10