title: Assessment of inflammatory response to transfemoral transcatheter aortic valve implantation compared to transapical and surgical procedures: a pilot study.
abstract: OBJECTIVE
  Surgical aortic valve replacement (AVR) has been associated with systemic inflammatory reactions. Yet, the role of inflammation following transcatheter aortic valve implantation (TAVI) has not been fully elucidated.
  
  
  RESULTS
  In a total of 40 patients evaluated by the 'heart team,' this retrospective study assessed levels of high-sensitive C-reactive protein (hs-CRP) and leukocyte counts following 'uneventful' AVR and TAVI. Four groups of matched patients were compared (AVR; transapical and transfemoral Edwards SAPIEN [TA ES and TF ES, respectively]; and transfemoral Medtronic CoreValve [TF CV]). A postprocedural increase of both hs-CRP levels and leukocyte counts was observed (P<.001) with peak levels 48 hours after the procedures. Comparing treatment groups, hs-CRP levels at 48 hours were significantly higher following AVR and TA ES compared to TF ES and TF CV (P<.04). Leukocyte counts at 48 hours were higher following TA ES compared to TF ES and TF CV (P<.03). Multivariate analysis incorporating both hs-CRP levels and leukocyte counts confirmed significant differences for all measurements over time (P<.001). Furthermore, the treatment group significantly influenced postprocedural hs-CRP levels and leukocyte counts (P<.001).
  
  
  CONCLUSIONS
  Both AVR and TAVI evoke a postprocedural inflammatory response. Higher hs-CRP levels and leukocyte counts following AVR and apical TAVI suggest less inflammation following femoral procedures.
authors.affiliation: Department of Cardiology, Cardiovascular Center, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland.
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Stähli
authors.forename: Jürg
authors.initials: J
authors.lastname: Grünenfelder
authors.forename: Stephan
authors.initials: S
authors.lastname: Jacobs
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.forename: Ulf
authors.initials: U
authors.lastname: Landmesser
authors.forename: Manfred B
authors.initials: MB
authors.lastname: Wischnewsky
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.forename: Roberto
authors.initials: R
authors.lastname: Corti
authors.forename: Willibald
authors.initials: W
authors.lastname: Maier
authors.forename: Lukas A
authors.initials: LA
authors.lastname: Altwegg
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002097:C-Reactive Protein / Q000032:analysis*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology; D007958:Leukocyte Count / Q000379:methods*; D008297:Male; D010865:Pilot Projects; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000097:blood*; D012107:Research Design; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002097:C-Reactive Protein