title: Bacterial translocation and plasma cytokines during transcatheter and open-heart aortic valve implantation.
abstract: OBJECTIVE
  To determine whether the good safety profile of transarterial aortic valve implantation (TAVI) is related to lower levels of systemic bacterial translocation and systemic inflammation compared with open-heart surgery.
  
  
  BACKGROUND
  Transcatheter aortic valve implantation via the transfemoral approach is increasingly used in very high-risk patients with aortic stenosis. The outcomes seem similar to those after open-heart aortic valve replacement (OHAVR).
  
  
  METHODS
  Each of 26 consecutive high-risk patients (EuroSCORE >20% for risk of operative death) who underwent TAVI (cases) was matched to the first low-risk patient treated next in our department using elective OHAVR without coronary artery bypass (control subjects). We collected severity, outcome, and echocardiography indicators before and after surgery; complications; proinflammatory cytokine levels; and markers for microbial translocation.
  
  
  RESULTS
  Despite greater illness severity, the TAVI patients had significantly lower vasopressor agent requirements, lower delirium rates, shorter hospital stays, and better hemodynamic findings compared with OHAVR patients. Vascular complications were more common after TAVI than after OHAVR (12, with seven requiring interventional therapy vs. 0, P = 0.006). Patients who underwent TAVI had lower blood transfusion requirements. Two TAVI patients died: one from iliac artery injury and the other from intracardiac prosthesis migration. Patients who underwent TAVI had lower plasma levels of endotoxin and bacterial peptidoglycan, as well as lower proinflammatory cytokine levels, suggesting less gastrointestinal bacterial translocation compared with OHAVR.
  
  
  CONCLUSIONS
  Compared with OHAVR, TAVI was associated with decreases in bacterial translocation and inflammation. These differences may explain the lower delirium rate and better hemodynamic stability observed, despite the greater disease severity in TAVI patients.
authors.affiliation: *Physiology Department, Cochin Academic Hospital, Paris Descartes University, Sorbonne Cite; †Cytokines & Inflammation Unit, Department of Infections and Epidemiology, Pasteur Institute; and ‡Cardiac Surgery Department, Paris Saint-Joseph Hospital, Paris Descartes University, Paris; §Cardiac Surgery Department, Marie-Lannelongue Hospital, Le Plessis-Robinson; and ∥Critical Care Unit, Melun General Hospital, Melun, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Adrie
authors.forename: Marianna
authors.initials: M
authors.lastname: Parlato
authors.forename: Lynda
authors.initials: L
authors.lastname: Salmi
authors.forename: Minou
authors.initials: M
authors.lastname: Adib-Conquy
authors.forename: Olivier
authors.initials: O
authors.lastname: Bical
authors.forename: Philippe
authors.initials: P
authors.lastname: Deleuze
authors.forename: Catherine
authors.initials: C
authors.lastname: Fitting
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Cavaillon
authors.forename: Mehran
authors.initials: M
authors.lastname: Monchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000097:blood / Q000382:microbiology / Q000601:surgery; D001419:Bacteria; D001424:Bacterial Infections / Q000097:blood / Q000209:etiology; D018988:Bacterial Translocation; D015415:Biomarkers / Q000097:blood; D016207:Cytokines / Q000097:blood*; D004731:Endotoxins / Q000097:blood*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D010457:Peptidoglycan / Q000097:blood*; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D016207:Cytokines; D004731:Endotoxins; D010457:Peptidoglycan