Occurrence and prognostic impact of systemic inflammatory response syndrome in transfemoral and transapical aortic valve implantation with balloon- and self-expandable valves

Abstract

Aims: Transcatheter aortic valve implantation (TAVI) is an alternative therapeutic option for patients with severe aortic valve stenosis (AS) and elevated surgical risk. Previous studies have suggested that the occurrence of systemic inflammatory response syndrome (SIRS) in patients undergoing TAVI is associated with an unfavourable outcome. We sought to assess the impact of different interventional access routes (transapical [TA] vs. transfemoral [TF]) and valve types (Medtronic CoreValve® [CV] vs. Edwards SAPIEN XT® [ES]) on the incidence of SIRS. In addition, the prognostic value of SIRS was evaluated.

Methods and results: Between January 2009 and July 2011 a total of 192 (out of 228) consecutive patients with severe aortic stenosis underwent TAVI at the University Hospital Frankfurt and were included in the current retrospective analysis. SIRS criteria were evaluated within the first 48 hours after TAVI. SIRS was defined according to existing definitions of the ACCP/SCCM Consensus Conference. A total of 75 (39.1%) patients developed SIRS at some time during the first 48 hours following TAVI. The occurrence of SIRS was independent from access route (TA 42.3% vs. TF 37.0%; p=0.28) as well as from type of valve used (ES 42.5% vs. CV 32.3%; p=0.11). However, the occurrence of SIRS was associated with a more than twofold higher one-year mortality rate (21.3%) compared to patients without SIRS in the first 48 hours (5.3%; p=0.04).

Conclusions: The occurrence of SIRS in the first 48 hours post procedure is associated with impaired prognosis following TAVI, but is independent from the chosen valve type and access route.