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经导管主动脉瓣手术后的免疫反应。

Immune response following transcatheter aortic valve procedure.

作者信息

Anaraki Kasra Talebi, Zahed Zahra, Javid Roozbeh Narimani, Shafiei Sasan, Beiranvandi Fereshteh, Kahrizsangi Negin Ghasemi, Golafshan Faraz, Arzhangzade Alireza, Kojuri Javad, Almassian Samin, Hadi Raha, Gholizadeh Pourya, Kazeminava Fahimeh

机构信息

Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Department of Medical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran.

出版信息

Vascul Pharmacol. 2024 Mar;154:107283. doi: 10.1016/j.vph.2024.107283. Epub 2024 Feb 9.

DOI:10.1016/j.vph.2024.107283
PMID:38340884
Abstract

Aortic valve stenosis is the most common type of heart valve disease in the United States and Europe and calcific aortic stenosis (AS) affects 2-7% of people aged 65 years and older. Aortic valve replacement (AVR) is the only effective treatment for individuals with this condition. Transcatheter Aortic Valve Replacement (TAVR) has been widely accepted as a minimally invasive therapeutic approach for addressing symptomatic AS in patients who are considered to have a high risk for traditional surgical intervention. TAVR procedure may have a paradoxical effect on the immune system and inflammatory status. A major portion of these immune responses is regulated by activating or inhibiting inflammatory monocytes and the complement system with subsequent changes in inflammatory cytokines. TAVR has the potential to induce various concurrent exposures, including disruption of the native valve, hemodynamic changes, antigenicity of the bioprosthesis, and vascular damage, which finally lead to the development of inflammation. On the other hand, it is important to acknowledge that TAVR may also have anti-inflammatory effects by helping in the resolution of stenosis.The inflammation and immune response following TAVR are complex processes that significantly impact procedural outcomes and patient well-being. Understanding the underlying mechanisms, identifying biomarkers of inflammation, and exploring therapeutic interventions to modulate these responses are crucial for optimizing TAVR outcomes. Further research is warranted to elucidate the precise immunological dynamics and develop tailored strategies to attenuate inflammation and enhance post-TAVR healing while minimizing complications.

摘要

在美国和欧洲,主动脉瓣狭窄是最常见的心脏瓣膜疾病类型,钙化性主动脉瓣狭窄(AS)影响2%至7%的65岁及以上人群。主动脉瓣置换术(AVR)是患有这种疾病的个体的唯一有效治疗方法。经导管主动脉瓣置换术(TAVR)已被广泛接受为一种微创治疗方法,用于治疗被认为传统手术干预风险高的有症状AS患者。TAVR手术可能对免疫系统和炎症状态产生矛盾的影响。这些免疫反应的很大一部分是通过激活或抑制炎性单核细胞和补体系统以及随后炎性细胞因子的变化来调节的。TAVR有可能引发各种并发暴露,包括天然瓣膜的破坏、血流动力学变化、生物假体的抗原性和血管损伤,最终导致炎症的发展。另一方面,必须认识到TAVR通过帮助解决狭窄也可能具有抗炎作用。TAVR后的炎症和免疫反应是复杂的过程,会显著影响手术结果和患者健康。了解潜在机制、识别炎症生物标志物以及探索调节这些反应的治疗干预措施对于优化TAVR结果至关重要。有必要进行进一步研究以阐明精确的免疫动力学,并制定量身定制的策略来减轻炎症、促进TAVR后愈合,同时将并发症降至最低。

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