IMR Press / RCM / Volume 23 / Issue 1 / DOI: 10.31083/j.rcm2301020
Open Access Original Research
Evaluation of systemic inflammation in response to remote ischemic preconditioning in patients undergoing transcatheter aortic valve replacement (TAVR)
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1 Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany
2 Berlin Health Institute, 10178 Berlin, Germany
3 DZHK (German Centre for Cardiovascular Research), partner site Berlin, 10785 Berlin, Germany
4 Department of Internal Medicine and Cardiology, Faculty of Medicine Carl Gustav Carus at Technische Universität Dresden, Herzzentrum Dresden, 01307 Dresden, Germany
5 Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
6 Institute for Medical Informatics and Biometry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
7 Department of Internal Medicine and Cardiology, HELIOS Klinikum Pirna, 01796 Pirna, Germany
8 Department of Cardiology, Faculty of Medicine Carl Gustav Carus at Technische Universität Dresden, Klinikum Chemnitz, 09116 Chemnitz, Germany
9 Department of Internal Medicine I, Faculty of Medicine Carl Gustav Carus at Technische Universität Dresden, Klinikum Görlitz, 02828 Görlitz, Germany
10 Department of Radiology, Faculty of Medicine Carl Gustav Carus at Technische Universität Dresden, Universitätsklinikum Dresden, 01307 Dresden, Germany
11 Center for Cardiology I, Heart Valve Center Mainz, University Medical Center Mainz, 55131 Mainz, Germany
12 Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany

These authors contributed equally.
Academic Editor: Vincenzo Lionetti

Rev. Cardiovasc. Med. 2022 , 23(1), 1; https://doi.org/10.31083/j.rcm2301020
Submitted: 8 October 2021 | Revised: 2 December 2021 | Accepted: 13 December 2021 | Published: 14 January 2022
(This article belongs to the Special Issue Translational Perioperative Cardioprotection)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Background: Systemic inflammation can occur after transcatheter aortic valve replacement (TAVR) and correlates with adverse outcome. The impact of remote ischemic preconditioning (RIPC) on TAVR associated systemic inflammation is unknown and was focus of this study. Methods: We performed a prospective controlled trial at a single center and included 66 patients treated with remote ischemic preconditioning (RIPC) prior to TAVR, who were matched to a control group by propensity score. RIPC was applied to the upper extremity using a conventional tourniquet. Definition of systemic inflammation was based on leucocyte count, C-reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6), assessed in the first 5 days following the TAVR procedure. Mortality was determined within 6 months after TAVR. RIPC group and matched control group showed comparable baseline characteristics. Results: Systemic inflammation occurred in 66% of all patients after TAVR. Overall, survival after 6 months was significantly reduced in patients with systemic inflammation. RIPC, in comparison to control, did not significantly alter the plasma levels of leucocyte count, CRP, PCT or IL-6 within the first 5 days after TAVR. Furthermore, inflammation associated survival after 6 months was not improved by RIPC. Of all peri-interventional variables assessed, only the amount of the applied contrast agent was connected to the occurrence of systemic inflammation. Conclusions: Systemic inflammation frequently occurs after TAVR and leads to increased mortality after 6 months. RIPC neither reduces the incidence of systemic inflammation nor improves inflammation associated patient survival within 6 months.

Keywords
Remote ischemic preconditioning
Transcatheter aortic valve replacement
Aortic valve stenosis
Systemic inflammatory response syndrome
Systemic inflammation
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