Journal
JOURNAL OF CARDIOVASCULAR TRANSLATIONAL RESEARCH
Volume 14, Issue 6, Pages 1104-1113Publisher
SPRINGER
DOI: 10.1007/s12265-021-10117-9
Keywords
TAVI; Thrombocytopenia; Platelet cell death; Phagocytic monocytes; Inflammatory cytokines
Funding
- Universita degli Studi di Napoli Federico II within the CRUI-CARE Agreement
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Thrombocytopenia is common and clinically detrimental after TAVI. Investigating platelet damage in different valve recipients revealed a potential role of the storage solution in inducing platelet injury and stimulating innate immunity. Larger prospective studies are needed to further explore this hypothesis.
Thrombocytopenia after TAVI is common and clinically detrimental. Retrospectively, we observed Portico recipients had a more profound platelet drop than Evolut recipients. We thus investigated periprocedural platelet damage and/orpro-inflammatory state in 64 TAVI recipients at baseline and after implantation. Platelet damage was assessed by annexin V staining and monocyte-phagocytic phenotype was assessed according to CD14/CD36 expression. Serum cytokines were measured in 20 patients. The formaldehyde-based storage solution altered platelets. When, before being loaded onto the delivery system, Portico underwent one additional flushing to those recommended, the receiving patients showed thrombocytopenia, platelet damage, and CD36-monocyte count were mitigated. A general increase in IL-6 was recorded in overall TAVI recipients, but a high serum level of IL-8, a potent thrombocytopenia inducer, was measured in Portico recipients only, including those with extra-rinsed valve. Our study suggests a platelet-injury effect by storage-solution and generates the hypothesis of a role for the biomaterial in stimulating innate-immunity. Larger prospective studies are needed.
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