Systemic inflammatory markers in elderly patients undergoing transcatheter aortic valve replacement

Haitham Abu Khadija; Mechael Welt; Gera Gendelman; Ahamd Hamode; Lion Poles; Michael Jonas; Mustafa Jaber; Gal Sella; Omar Ayyad; Sagi Tshori; Alex Blatt; Jacob George

摘要：BACKGROUND Transcatheter aortic valve replacement (TAVR) provokes an early injury response, partially represented by dynamic changes in inflammatory markers. TAVR greatly benefits the elderly and we aimed to determine whether increased in-flammatory markers post-TAVR in octagenerians were different than their younger counterparts and whether it was associated with adverse clinical outcomes.METHODS Patients with severe symptomatic aortic stenosis who underwent transfemoral TAVR from January 2010 to December 2021 were enrolled. Total white blood cells (WBC) countand subpopulation dynamics were evaluated. RESULTS Five-hundred and seven patients were finally included in the study, 65％ of these patients were 80 or more years old (54％ female, median age 84 [82-87]) years, with severe symptomatic aortic stenosis. In patients aged above 80 years (patients ≥80), we noticed significant kinetic changes in the WBC and their differential cellular subpopulations (P < 0.0001) between admis-sion and early days post-procedure. This was evident by a significant increase in total WBC (median 7.1 to 9.4) and absolute neut-rophil count (median 4.7 to 7.4), neutrophil–lymphocyte (NL) ratio (median 2.82 to 7.21), and a meaningful decrease in absolute lymphocyte count (median 1.5 to 1.0). Implantation of self-expandable valves (SEVs) was associated with a more pronounced in-flammatory response than balloon-expandable valves (BEVs). Higher WBC and neutrophil counts were associatedwith higher mortality and major vascular complications at 30 days, in addition, higher neutrophil counts and NL ratios were found to be cor-related to arrhythmia at 30 days with P values of 0.04 and 0.028, respectively. CONCLUSION This is the first description of a differential age-related inflammatory response in patients after TAVR, which shows an association between inflammatory markers post procedure and clinical outcome. Nevertheless, survival rates were sim-ilar in the elderly population and in younger patients, despite the presence of comorbid conditions.