Inflammatory immune response in recipients of transcatheter aortic valvesCentral MessagePerspective
Cecilia Veraar, MD,
Matthias Koschutnik, MD,
Christian Nitsche, MD,
Maria Laggner, PhD,
Dominika Polak, PhD,
Barbara Bohle, PhD,
Andreas Mangold, MD, PhD, MBA,
Bernhard Moser, MD, PhD, MBA,
Julia Mascherbauer, MD,
Hendrik J. Ankersmit, MD, MBA
Affiliations
Cecilia Veraar, MD
Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesiology, General Intensive Care, and Pain Medicine, Medical University of Vienna, Vienna, Austria; Laboratory for Cardiac and Thoracic Diagnosis, Regeneration and Applied Immunology, Medical University of Vienna, Vienna, Austria
Matthias Koschutnik, MD
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
Christian Nitsche, MD
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
Maria Laggner, PhD
Laboratory for Cardiac and Thoracic Diagnosis, Regeneration and Applied Immunology, Medical University of Vienna, Vienna, Austria; Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
Dominika Polak, PhD
Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
Barbara Bohle, PhD
Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
Andreas Mangold, MD, PhD, MBA
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
Bernhard Moser, MD, PhD, MBA
Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
Julia Mascherbauer, MD
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria; Department of Internal Medicine III, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria
Hendrik J. Ankersmit, MD, MBA
Laboratory for Cardiac and Thoracic Diagnosis, Regeneration and Applied Immunology, Medical University of Vienna, Vienna, Austria; Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria; Address for reprints: Hendrik J. Ankersmit, MD, MBA, Department of Thoracic Surgery, Laboratory for Cardiac and Thoracic Diagnosis, Regeneration, and Applied Immunology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Objective: Transcatheter aortic valve implantation (TAVI) is rapidly replacing cardiac surgery due to its minimal invasiveness and practicality. Midterm immunological studies on the biocompatibility of galactose-alpha-1,3-galactose (α-Gal)–carrying bioprosthetic heart valves for TAVI are not available. In this study we investigated whether bioprosthetic heart valves employed for TAVI augment an α-Gal–specific antibody-dependent and antibody-independent immune response 3 months after TAVI implantation. Methods: This prospective observational study included 27 patients with severe aortic valve stenosis undergoing TAVI and 10 patients with severe mitral valve regurgitation treated with a transcatheter MitraClip (Abbott Laboratories, Abbott Park, Ill) procedure. Blood samples were drawn before and 90 days after treatment at a routine checkup. Serum samples were analyzed using enzyme-linked immunosorbent assay. Serum concentrations of α-Gal–specific immunoglobulin (Ig) G, IgG subclasses and IgE, complement factor 3a, NETosis-specific citrullinated H3, and the systemic inflammation markers soluble suppression of tumorigenicity and interleukin 33 were evaluated. Results: Three months after TAVI, we found significantly increased serum concentrations of α-Gal–specific IgG3, complement factor complement factor 3a, citrullinated H3 levels, and soluble suppression of tumorigenicity (P = .002, P = .001, P = .025, and P = .039, respectively). Sensitization of α-Gal–specific IgE antibodies occurred in 55% of all patients after TAVI. Conclusions: Our results indicate that TAVI elicits a midterm, specific humoral immune response against α-Gal and causes an unspecific humoral inflammation compared with patients undergoing MitraClip implantation. This observation will lead to a better understanding of postintervention morbidity and the long-term durability of bioprostheses and indicates that caution is appropriate when designing implantation strategies for younger patients.
