Endothelial Dysfunction Clinical Trial
Official title:
Evaluation of Endothelial Dysfunction During Aortic Valvular Replacement by Bioprosthesis With and Without Extracorporeal Circulation
Patients with aortic stenosis present many risk factors for endothelial dysfunction (arterial
hypertension, arteriosclerosis, dyslipidemia, chronic renal insufficiency, etc.). It is
likely that a significant number of patients suffer from pre-existing endothelial dysfunction
that can be evaluated by a molecular approach.
To date, the replacement of the aortic valve can be performed by surgery with extracorporeal
circulation (CEC) or percutaneous (Transcatheter Aortic Valve ImplantationTAVI) without CEC.
Two recent studies have demonstrated a sustained improvement in endothelial function with
TAVI. On the contrary, studies have demonstrated that post-operative complications
(coagulopathy, capillary leak syndrome, acute vasoplastic disorder and acute renal failure)
after surgery with extracorporeal circulation (CEC) could be the result of the interaction
between pre-existing endothelial dysfunction And the "operative" aggression associated with
the CEC.
Thus, patients with preexisting involvement of endothelial function would develop vascular
dysfunction after valvular replacement due to "endothelial activation" related to CEC. This
phenomenon would not exist in TAVI, and would explain the absence of so-called vascular
dysfunction complications (Systemic inflammatory response syndrome, vasoplastic syndrome,
disseminated intravascular coagulation).
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