Prognostic value of systemic inflammatory response syndrome after transcatheter aortic valve implantation

Abstract

AimsSystemic inflammatory response syndrome (SIRS) could affect mortality after transcatheter aortic valve implantation (TAVI) up to 12 months of follow-up. The aim of this study was to evaluate the prevalence of SIRS after TAVI and its impact on all-cause mortality up to 24 months follow-up.MethodsWe retrospectively enrolled 132 patients with symptomatic severe aortic stenosis undergoing TAVI. SIRS development during the first 72 h after the intervention was evaluated. Other postoperative complications were defined according to the Valve Academic Research Consortium 2 (VARC2). All patients underwent follow-up at 30 days and 24 months. Endpoints were 30-days and 24-months mortality.ResultsPost-TAVI SIRS developed in 27 patients (20%). At 30-day follow-up, all-cause death occurred in 10 (8%) patients and SIRS occurred more frequently in patients with adverse short-term outcome (60 vs. 17%; P = 0.001). Twenty-four months all-cause death occurred in 25 (19%) patients. SIRS resulted as an independent predictor of long-term outcome [hazard ratio 3.7; 95% confidence interval (95% CI) 1.5–9; P = 0.004], along with major vascular complications (hazard ratio 4; 95% CI 1.6–9.9; P = 0.003), relevant bleedings (hazard ratio 6.4; 95% CI 1.5–28; P = 0.013) and baseline pulmonary hypertension (hazard ratio 2.4; 95% CI 1.05–5.6; P = 0.039).ConclusionPostoperative SIRS was more frequent in patients who died at 30 days follow-up. Moreover, SIRS resulted as a predictor of 24-month mortality along with vascular complications, relevant bleedings and baseline pulmonary hypertension.

Atrial fibrillation before and after transcatheter aortic valve implantation: short- and long-term clinical implications

“…24 Atrial fibrillation before and after transcatheter aortic valve implantation Arrotti et al 55 A slightly different analysis was made by Monosilio et al and their evaluation included VARC outcomes, although they focused on postoperatory SIRS which resulted as a predictor of 24-month mortality. 25 Patients with pre-AF had a higher probability of an early bleeding after TAVI than patients in sinus rhythm (OR 17.41, 95% CI 6.49-46.68, P ¼ 0.03). 22 Studies on mortality in patients with preexisting and newonset AF after TAVI showed counteracting results.…”

“…A slightly different analysis was made by Monosilio et al and their evaluation included VARC outcomes, although they focused on postoperatory SIRS which resulted as a predictor of 24-month mortality. 25 …”

Acute expansion of nitinol-based self-expandable device in patients undergoing transfemoral aortic valve implantation

“…[1][2][3][4][5] In the last decade, many efforts have been made to improve patient selection for TAVR, and reduce procedural complications and adverse outcomes. [6][7][8][9][10][11][12][13] In patients undergoing TAVR, prosthesis adaptation to the aortic root is of paramount importance to avoid severe paravalvular leaks, achieve an effective orifice area and minimize patientprosthesis mismatch. 14,15 Of interest, it is widely described that TAVR with a balloon-expandable valve was systematically associated with a certain degree of valve stent recoil.…”

“…Transcatheter aortic valve replacement (TAVR) is the treatment of choice for patients with severe symptomatic aortic stenosis and has become the preferred strategy in patients at intermediate/high surgical risk 1–5 . In the last decade, many efforts have been made to improve patient selection for TAVR, and reduce procedural complications and adverse outcomes 6–13 . In patients undergoing TAVR, prosthesis adaptation to the aortic root is of paramount importance to avoid severe paravalvular leaks, achieve an effective orifice area and minimize patient–prosthesis mismatch 14,15 …”