Advertisement

Effect on Mortality of Systemic Thromboinflammatory Response After Transcatheter Aortic Valve Implantation

Published:September 09, 2019DOI:https://doi.org/10.1016/j.amjcard.2019.08.036
      After transcatheter aortic valve implantation (TAVI) there is consistently identified decrease in platelets accompanied by a leucocyte (white blood cell, WBC) increase. We aimed to analyze the prognostic value of early platelet and WBC count changes (thromboinflammatory response) after successful TAVI. Among 432 consecutive patients [median 83.0 years of age, 63.4% women], platelets and WBCs were measured before and for 7 days post-TAVI. Follow-up was 36.9 (21.4 to 48.0) months. Platelet decrease (∆%Platelet-max) and parallel WBC increase (∆%WBC-max) were seen at days 1 to 3. Both ∆%Platelet-max ≤−37.6% and ∆%WBC-max >72.5% predicted mortality (area under the curve = 0.569 and area under the curve = 0.626). The 30-day and 1-year mortality (13.1% and 26.2%) were highest among 28% patients with a greater decrease in platelets and a greater increase in WBCs; intermediate (0.9% and 12.3%) among 52.5% patients with either a greater decrease in platelets or a greater increase in WBCs, but not both; and lowest (0% and 6.6%) among 19.5% patients with a lesser decrease in platelets and a lesser increase in WBCs (p <0.001). Estimated 4-year mortality rates were 53.7% versus 36.2% versus 24.5%, respectively, p <0.001. Bleeding, surgical wounds, acute kidney, and brain injury predicted a more intense thromboinflammatory response, whereas use of the newer generations had the opposite effect. In conclusion, substantial thromboinflammatory response identified after successful TAVI predicts a higher long-term mortality.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Dvir D
        • Généreux P
        • Barbash IM
        • Kodali S
        • Ben-Dor I
        • Williams M
        • Torguson R
        • Kirtane AJ
        • Minha S
        • Badr S
        • Pendyala LK
        • Loh JP
        • Okubagzi PG
        • Fields JN
        • Xu K
        • Chen F
        • Hahn RT
        • Satler LF
        • Smith C
        • Pichard AD
        • Leon MB
        • Waksman R
        Acquired thrombocytopenia after transcatheter aortic valve replacement: clinical correlates and association with outcomes.
        Eur Heart J. 2014; 35: 2663-2671
        • Shrestha M
        • Folliguet T
        • Meuris B
        • Dibie A
        • Bara C
        • Herregods MC
        • Khaladj N
        • Hagl C
        • Flameng W
        • Laborde F
        • Haverich A
        Sutureless Perceval S aortic valve replacement: a multicenter, prospective pilot trial.
        J Heart Valve Dis. 2009; 18: 698-702
        • Sinning JM
        • Scheer AC
        • Adenauer V
        • Ghanem A
        • Hammerstingl C
        • Schueler R
        • Müller C
        • Vasa-Nicotera M
        • Grube E
        • Nickenig G
        • Werner N
        Systemic inflammatory response syndrome predicts increased mortality in patients after transcatheter aortic valve implantation.
        Eur Heart J. 2012; 33: 1459-1468
        • Sexton TR
        • Wallace EL
        • Chen A
        • Charnigo RJ
        • Reda HK
        • Ziada KM
        • Gurley JC
        • Smyth SS
        Thromboinflammatory response and predictors of outcomes in patients undergoing transcatheter aortic valve replacement.
        J Thromb Thrombolysis. 2016; 41: 384-393
        • Chmielak Z
        • Witkowski A
        • Dąbrowski M
        • Demkow M
        • Kuśmierski K
        • Sitkowska E
        • Jastrzębski J
        • Szymański P
        • Hryniewiecki T
        • Czerwińska K
        • Stępińska J
        Comparison of mid-term results of transcatheter aortic valve implantation in high-risk patients with logistic EuroSCORE ≥ 20% or < 20.
        Kardiol Pol. 2016; 74: 224-230
        • Pilgrim T
        • Lee JKT
        • O'Sullivan CJ
        • Stortecky S
        • Ariotti S
        • Franzone A
        • Lanz J
        • Heg D
        • Asami M
        • Praz F
        • Siontis GCM
        • Vollenbroich R
        • Räber L
        • Valgimigli M
        • Roost E
        • Windecker S
        Early versus newer generation devices for transcatheter aortic valve implantation in routine clinical practice: a propensity score matched analysis.
        Open Heart. 2018; 5e000695
        • Grube E
        • Laborde JC
        • Gerckens U
        • Felderhoff T
        • Sauren B
        • Buellesfeld L
        • Mueller R
        • Menichelli M
        • Schmidt T
        • Zickmann B
        • Iversen S
        • Stone GW
        Percutaneous implantation of the corevalve self-expanding valve prosthesis in high-risk patients with aortic valve disease: the Siegburg first-in-man study.
        Circulation. 2006; 114: 1616-1624
        • McCabe JM
        • Huang PH
        • Riedl LA
        • Devireddy SR
        • Grondell J
        • Connors AC
        • Davidson MJ
        • Eisenhauer AC
        • Welt FG
        Incidence and implications of idiopathic thrombocytopenia following transcatheter aortic valve replacement with the Edwards Sapien(©) valves: a single center experience.
        Catheter Cardiovasc Interv. 2014; 83: 633-641
        • Gallet R
        • Seemann A
        • Yamamoto M
        • Hayat D
        • Mouillet G
        • Monin JL
        • Gueret P
        • Couetil JP
        • Dubois-Randé JL
        • Teiger E
        • Lim P
        Effect of transcatheter (via femoral artery) aortic valve implantation on the platelet count and its consequences.
        Am J Cardiol. 2013; 111: 1619-1624
        • Jilaihawi H
        • Doctor N
        • Chakravarty T
        • Kashif M
        • Mirocha J
        • Cheng W
        • Lill M
        • Nakamura M
        • Gheorghiu M
        • Makkar RR
        Major thrombocytopenia after balloon-expandable transcatheter aortic valve replacement: prognostic implications and comparison to surgical aortic valve replacement.
        Catheter Cardiovasc Interv. 2015; 85: 130-137
        • Sedaghat A
        • Falkenberg N
        • Sinning JM
        • Kulka H
        • Hammerstingl C
        • Nickenig G
        • Oldenburg J
        • Pötzsch B
        • Werner N
        TAVI induces an elevation of hemostasis-related biomarkers, which is not causative for post-TAVI thrombocytopenia.
        Int J Cardiol. 2016; 221: 719-725
        • Lindman BR
        • Goldstein JS
        • Nassif ME
        • Zajarias A
        • Novak E
        • Tibrewala A
        • Vatterott AM
        • Lawler C
        • Damiano RJ
        • Moon MR
        • Lawton JS
        • Lasala JM
        • Maniar HS
        Systemic inflammatory response syndrome after transcatheter or surgical aortic valve replacement.
        Heart. 2015; 101: 537-545
        • Rettig TC
        • Rigter S
        • Nijenhuis VJ
        • van Kuijk JP
        • ten Berg JM
        • Heijmen RH
        • van de Garde EM
        • Noordzij PG
        The systemic inflammatory response syndrome predicts short-term outcome after transapical transcatheter aortic valve implantation.
        J Cardiothorac Vasc Anesth. 2015; 29: 283-287
        • Schwietz T
        • Behjati S
        • Gafoor S
        • Seeger F
        • Doss M
        • Sievert H
        • Zeiher AM
        • Fichtlscherer S
        • Lehmann R
        Occurrence and prognostic impact of systemic inflammatory response syndrome in transfemoral and transapical aortic valve implantation with balloon- and self-expandable valves.
        EuroIntervention. 2015; 10: 1468-1473
        • Dangas GD
        • Lefèvre T
        • Kupatt C
        • Tchetche D
        • Schäfer U
        • Dumonteil N
        • Webb JG
        • Colombo A
        • Windecker S
        • JM0 Ten Berg
        • Hildick-Smith D
        • Mehran R
        • Boekstegers P
        • Linke A
        • Tron C
        • Van Belle E
        • Asgar AW
        • Fach A
        • Jeger R
        • G0 Sardella
        • Hink HU
        • Husser O
        • Grube E
        • Deliargyris EN
        • Lechthaler I
        • Bernstein D
        • Wijngaard P
        • Anthopoulos P
        • Hengstenberg C
        • BRAVO- Investigators
        Bivalirudin versus heparin anticoagulation in transcatheter aortic valve replacement: the randomized BRAVO-3 trial.
        J Am Coll Cardiol. 2015; 66: 2860-2868
        • Sexton T
        • Alkhasova M
        • de Beer M
        • Lynch D
        • Smyth S
        Changes in thromboinflammatory profiles across the generations of transcatheter aortic heart valves.
        J Thromb Thrombolysis. 2019; 47: 174-178
        • Shishikura D
        • Kataoka Y
        • Pisaniello AD
        • Delacroix S
        • Montarello JK
        • Nicholls SJ
        • Worthley SG
        The extent of aortic atherosclerosis predicts the occurrence, severity, and recovery of acute kidney injury after transcatheter aortic valve replacement.
        Circ Cardiovasc Interv. 2018; 11e006367
        • Kakefuda Y
        • Hayashida K
        • Yamada Y
        • Yashima F
        • Inohara T
        • Yanagisawa R
        • Tanaka M
        • Arai T
        • Kawakami T
        • Maekawa Y
        • Tsuruta H
        • Itabashi Y
        • Murata M
        • Sano M
        • Okamoto K
        • Yoshitake A
        • Shimizu H
        • Jinzaki M
        • Fukuda K
        Impact of subclinical vascular complications detected by systematic postprocedural multidetector computed tomography after transcatheter aortic valve implantation using balloon-expandable Edwards SAPIEN XT heart valve.
        Am J Cardiol. 2017; 119: 1100-1105