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Thorac Cardiovasc Surg 2011; 59(8): 465-469
DOI: 10.1055/s-0031-1280370
Original Cardiovascular/Society Paper

© Georg Thieme Verlag KG Stuttgart · New York

Inflammatory Response in Transapical Transaortic Valve Replacement

A. Goetzenich1 , A. Roehl1 , J. Spillner2 , M. Haushofer2 , G. Dohmen2 , L. Tewarie2 , A. Moza3
  • 1Department of Anesthesiology, University Clinic RWTH Aachen, Aachen, Germany
  • 2Clinic for Cardiothoracic and Vascular Surgery, University Clinic RWTH Aachen, Aachen, Germany
  • 3Department of Cardiac Surgery and Transplantation, Royal Brompton and Harefield NHS Foundation Trust, Harefield, United Kingdom
Further Information

Publication History

received April 26, 2011 resubmitted August 1, 2011

accepted Sept. 12, 2011

Publication Date:
11 November 2011 (online)

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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. Method: 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. Conclusion: 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.

Key words

aortic valve and root - inflammation - systemic (includes cells - mediators) - heart valve - transapical - percutaneous

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Dr. Andreas Goetzenich, MD

Department of Anesthesiology
Research Fellow & Specialist in Anesthesiology
University Clinic RWTH Aachen

Pauwellstr. 30

52074 Aachen

Germany

Phone: +49 24 18 00

Fax: +49 24 13 33 55 56

Email: agoetzenich@ukaachen.de

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