Please cite this article as: Khadija HA, Walt M, Gendelman G, Hamode A, Poles L, Jonas M, Jaber M, Sella G, Ayyad O, Tshori S, Blatt A, George J. Systemic inflammatory markers in elderly patients undergoing transcatheter aortic valve replacement. J Geriatr Cardiol 2022; 19(11): 811−821. DOI: 10.11909/j.issn.1671-5411.2022.11.009.
Citation: Please cite this article as: Khadija HA, Walt M, Gendelman G, Hamode A, Poles L, Jonas M, Jaber M, Sella G, Ayyad O, Tshori S, Blatt A, George J. Systemic inflammatory markers in elderly patients undergoing transcatheter aortic valve replacement. J Geriatr Cardiol 2022; 19(11): 811−821. DOI: 10.11909/j.issn.1671-5411.2022.11.009.
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Systemic inflammatory markers in elderly patients undergoing transcatheter aortic valve replacement

    Abstract
  •  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 inflammatory 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) count and 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 admission and early days post-procedure. This was evident by a significant increase in total WBC (median 7.1 to 9.4) and absolute neutrophil 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 inflammatory response than balloon-expandable valves (BEVs). Higher WBC and neutrophil counts were associated with higher mortality and major vascular complications at 30 days, in addition, higher neutrophil counts and NL ratios were found to be correlated 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 similar in the elderly population and in younger patients, despite the presence of comorbid conditions.
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