GVM Care & Research, Department of Cardiovascular Surgery, Anthea Hospital, Bari, Italy; Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy.
GVM Care & Research, Department of Cardiovascular Surgery, Anthea Hospital, Bari, Italy.
Int J Surg. 2019 Mar;63:1-7. doi: 10.1016/j.ijsu.2019.01.014. Epub 2019 Jan 28.
The effects of surgical aortic valve replacement versus transcatheter aortic valve replacement on endothelial function are unknown. We investigated the effects of surgical and transcatheter aortic valve replacement on early and 90-day endothelial function measured by brachial flow mediated dilation and apoptotic rate in the human umbilical vein endothelial cells in patients with significant aortic stenosis, intermediate risk of surgery, and no coronary artery disease.
We conducted a prospective observational case control single-blind study at a single tertiary center. Endothelial function was measured at baseline, early post-procedure (4 days), and follow-up (90 days). A blood pressure cuff was used to elicit reactive hyperemia for measuring brachial wall shear stress and flow mediated dilation. The apoptosis rate was observed in the human umbilical vein endothelial cells after 48-h incubation with 20% serum from patients. The rate of apoptosis was assessed by determining the number of annexin V and propidium iodide positive cells by flow cytometry.
Early post-procedure flow dilation was significant lower in the surgical group (p < 0.003). At follow-up, both groups showed incremental increases in flow mediated dilation. Surgical group apoptotic rate did not significantly change, while transcatheter apoptotic rate steadily decreased, suggesting a trend toward improved endothelial function.
The data suggest that conventional surgical aortic valve replacement may be associated with an early and transient decrease in endothelial function, likely due to the use of cardio-pulmonary bypass.
关于外科主动脉瓣置换术与经导管主动脉瓣置换术对血管内皮功能的影响，目前尚无定论。我们研究了外科主动脉瓣置换术与经导管主动脉瓣置换术对存在严重主动脉瓣狭窄、手术风险中等且无冠心病的患者的早期和 90 天血管内皮功能（通过肱动脉血流介导的舒张和人脐静脉内皮细胞凋亡率测量）的影响。
我们在一家单中心的三级医院进行了前瞻性观察性病例对照单盲研究。在基线、术后早期（4 天）和随访（90 天）时测量内皮功能。使用血压袖带引起反应性充血，以测量肱动脉壁切应力和血流介导的舒张。将患者 20%血清与人脐静脉内皮细胞孵育 48 小时后，观察人脐静脉内皮细胞的凋亡率。通过流式细胞术确定 Annexin V 和碘化丙啶阳性细胞的数量来评估凋亡率。
外科组术后早期的血流扩张明显较低（p<0.003）。在随访时，两组的血流介导的舒张均有递增性增加。外科组的凋亡率没有显著变化，而经导管组的凋亡率则稳定下降，表明内皮功能有改善的趋势。
数据表明，传统的外科主动脉瓣置换术可能与早期和短暂的血管内皮功能下降有关，这可能是由于使用体外循环。
