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Objective: Cardiovascular risk factors as well as the surgical trauma affect the endothelial integrity resulting in the detachment of endothelial cells into the blood stream. Here, we introduce a novel, automated method for the enumeration of circulating endothelial cells (CEC) in order to determine the preoperative risk and the procedural invasiveness in patients undergoing either transcatheter (TAVR) or conventional aortic valve replacement (CAVR).
Methods: 22 consecutive patients with severe aortic stenosis were enrolled assigned to either CAVR or TAVR by heart team decision. Patient demographics, preoperative characteristics and postoperative outcome were analyzed. CECs were enumerated applying isotype controlled flow cytometry, including automated pre-enrichment of CD34+ blood cells.
Results: TAVR-patients were older (81.0±4.8 yrs vs 69.1±11.2 yrs, p=0.004), with higher Euro-/STS-score (9.6±2.9 vs 5.2±1.8, p<0.001), higher serum creatinine levels (1.5±0.9 mg/dl vs 0.9±0.3 mg/dl, p=0.042), higher rate of preoperative cardiac failure (0% vs 36.4%, p=0.045), and lower hemoglobin (11.6±1.5 g/dl vs 13.81±1.29 g/dl, p=0.001). CEC frequencies were significantly higher in the TAVR-group preoperatively (9.8 ±4.1 /ml vs 5.5±2.2 /ml, p=0.019) and 1h postoperatively (13.4±5.1 /ml vs 8.2±4.1 /ml, p=0.03). 5d postop. CEC-frequency was significantly increased in the AVR group (39.0±13.0 /ml vs 14.3±4.4 /ml, p<0.001). There was a significant correlation between preoperative Euro- and STS score (9.55±2.98 (TAVI) vs 5.18±1.78 (AVR), p<0.001) and CEC (9.8±4.1 /ml (TAVR) vs 5.5±2.2 /ml (CAVR), p=0.019). Additionally, all patients with preoperative CEC>10 /ml developed postoperative atrial-fibrillation, more transfusion requirements, prolonged ICU-stay, higher rate of transitory psychotic disorder and paravalvular leakage.
Conclusions: Initial results show that the frequency of CEC is a predictive clinical marker for assessment of preoperative risk, surgical invasiveness and clinical outcome. However, further studies are necessary to validate practical clinical usefulness and potential superiority compared to conventional markers.