title: Technical Approach Determines Inflammatory Response after Surgical and Transcatheter Aortic Valve Replacement.
abstract: OBJECTIVE
  To investigate the periprocedural inflammatory response in patients with isolated aortic valve stenosis undergoing surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) with different technical approaches.
  
  
  METHODS
  Patients were prospectively allocated to one of the following treatments: SAVR using conventional extracorporeal circulation (CECC, n = 47) or minimized extracorporeal circulation (MECC, n = 15), or TAVI using either transapical (TA, n = 15) or transfemoral (TF, n = 24) access. Exclusion criteria included infection, pre-procedural immunosuppressive or antibiotic drug therapy and emergency indications. We investigated interleukin (IL)-6, IL-8, IL-10, human leukocyte antigen (HLA-DR), white blood cell count, high-sensitivity C-reactive protein (hs-CRP) and soluble L-selectin (sCD62L) levels before the procedure and at 4, 24, and 48 h after aortic valve replacement. Data are presented for group interaction (p-values for inter-group comparison) as determined by the Greenhouse-Geisser correction.
  
  
  RESULTS
  SAVR on CECC was associated with the highest levels of IL-8 and hs-CRP (p<0.017, and 0.007, respectively). SAVR on MECC showed the highest descent in levels of HLA-DR and sCD62L (both p<0.001) in the perioperative period. TA-TAVI showed increased intraprocedural concentration and the highest peak of IL-6 (p = 0.017). Significantly smaller changes in the inflammatory markers were observed in TF-TAVI.
  
  
  CONCLUSIONS
  Surgical and interventional approaches to aortic valve replacement result in inflammatory modulation which differs according to the invasiveness of the procedure. As expected, extracorporeal circulation is associated with the most marked pro-inflammatory activation, whereas TF-TAVI emerges as the approach with the most attenuated inflammatory response. Factors such as the pre-treatment patient condition and the extent of myocardial injury also significantly affect inflammatory biomarker patterns. Accordingly, TA-TAVI is to be classified not as an interventional but a true surgical procedure, with inflammatory biomarker profiles comparable to those found after SAVR. Our study could not establish an obvious link between the extent of the periprocedural inflammatory response and clinical outcome parameters.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Gabor
authors.initials: G
authors.lastname: Erdoes
authors.affiliation: Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.|Department of Clinical Research, Anesthesiology Group, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Lippuner
authors.affiliation: 2nd Department of Obstetrics and Gynecology, Semmelweis University of Medicine, Budapest, Hungary.
authors.forename: Istvan
authors.initials: I
authors.lastname: Kocsis
authors.affiliation: Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.|Department of Clinical Research, Anesthesiology Group, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Marcel
authors.initials: M
authors.lastname: Schiff
authors.affiliation: Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Monika
authors.initials: M
authors.lastname: Stucki
authors.affiliation: Department of Cardiovascular Surgery, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Balthasar
authors.initials: B
authors.lastname: Eberle
authors.affiliation: Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.|Department of Clinical Research, Anesthesiology Group, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Frank
authors.initials: F
authors.lastname: Stueber
authors.affiliation: Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.|Department of Clinical Research, Anesthesiology Group, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: Malte
authors.initials: M
authors.lastname: Book
mesh_terms: D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D016207:Cytokines / Q000097:blood; D005260:Female; D006684:HLA-DR Antigens / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology* / Q000473:pathology*; D019041:L-Selectin; D007958:Leukocyte Count; D008297:Male; D012995:Solubility; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000379:methods*
chemical_list: D015415:Biomarkers; D016207:Cytokines; D006684:HLA-DR Antigens; D019041:L-Selectin; D002097:C-Reactive Protein