Differential systemic inflammatory responses after TAVI: The role of self versus balloon expandable devices

Abstract

Objective Transcatheter aortic valve implantation (TAVI) provokes early injury response, represented in part by dynamic changes in the inflammatory markers. The association of self-expanding valves (SEVs) and balloon-expandable valves (BEVs) with the consequent inflammatory response remains uncertain. Materials and methods Patients with severe symptomatic aortic stenosis who underwent transfemoral TAVI: SEVs or BEVs, from January 2010 to December 2019 were enrolled. Whole white blood cells (WBC) and subpopulation dynamics as well the neutrophil to lymphocyte ratio (NLR) were evaluated. Results Three-hundred seventy consecutive patients (mean age 81.75 ± 6.8 years, 199 women’s) were enrolled. In the entire population, significant kinetic changes in the WBC response (p <0.0001) between admission and first 24 hours post procedure, with a significant increase in total WBC (7.46 ± 2.26 to 10.08 ± 3.55) and absolute neutrophil count (4.97 ± 2.06 to 8.19 ± 3.43), NL ratio (3.72 ± 2.8 to 9.76 ± 7.29), and a meaningful decrease in absolute lymphocytes count (1.67 ± 1.1 to 1.1 ± 0.76). When compared between the types of valves, SEVs were associated with a more pronounced inflammatory response than BEVs, with total WBC (10.44 ± 3.86 vs. 9.45 ± 3.19) neutrophils (8.56 ± 3.75 vs. 7.55 ± 3.06) with p 0.016 and 0.012 respectively. Conclusion This is the first description of a differential inflammatory response between the two leading delivery systems. SEV appears to trigger a more robust inflammatory response as compared to BEV. Clinical studies are warranted to assess the long term effect of our findings.

The predictive value of neutrophil to lymphocyte ratio and mean platelet volume on acute kidney injury after TAVI

“…The NLR has been identified as a predictive marker of systemic inflammation in various diseases. [15][16][17] NLR reflects the dynamic interaction between innate (neutrophils) and adaptive cellular immunological responses to disease and diverse pathological circumstances, The NLR has been associated with AKI. Yelgeç et al 18 found that post-procedural NLR was an independent risk factor for AKI (OR: 1.79; p=0.01).…”

“…The NLR has been identified as a predictive marker of systemic inflammation in a number of cardiovascular and non-cardiovascular diseases. [15][16][17] Following TAVI, the NLR has been linked to the development of AKI. [18][19][20] The average platelet volume (MPV) is a computerized measurement of platelet size.…”

Technical Aspects and Development of Transcatheter Aortic Valve Implantation

“…A neutrophil-to-lymphocyte ratio can be used as a prognostic marker in TAVI patients [ 36 ]. TAVI-associated SIRS is more extensive with self-expanding compared to balloon-expandable devices [ 37 ]. This could be partially explained by more pronounced endothelial injury (due to oversizing and continuous pressure to surrounding tissues) and an increased inflammatory reaction to a foreign body placement (due to the presence of residual cells, DNA, and the alpha-Gal epitope in porcine-derived materials) of self-expanding devices [ 37 ].…”

“…TAVI-associated SIRS is more extensive with self-expanding compared to balloon-expandable devices [ 37 ]. This could be partially explained by more pronounced endothelial injury (due to oversizing and continuous pressure to surrounding tissues) and an increased inflammatory reaction to a foreign body placement (due to the presence of residual cells, DNA, and the alpha-Gal epitope in porcine-derived materials) of self-expanding devices [ 37 ]. Endothelial injury and foreign material placement trigger the immune response, which begins with fibrinogen adsorption and platelet activation followed by recruitment of circulating leukocytes [ 37 ].…”

“…This could be partially explained by more pronounced endothelial injury (due to oversizing and continuous pressure to surrounding tissues) and an increased inflammatory reaction to a foreign body placement (due to the presence of residual cells, DNA, and the alpha-Gal epitope in porcine-derived materials) of self-expanding devices [ 37 ]. Endothelial injury and foreign material placement trigger the immune response, which begins with fibrinogen adsorption and platelet activation followed by recruitment of circulating leukocytes [ 37 ]. Titanium content enhances fibrinogen adsorption [ 38 ], which could partially explain a pronounced immune response following TAVI with self-expanding devices.…”