Valvular Heart Disease Clinical Trial
Official title:
Inflammatory and Vasoactive Mediator Profiles and Pathogen Characterization During Heart Valve Replacement Surgery
The study aims at the comparative examination of pre-, intra- and post-operative release profiles of inflammatory and vasoactive mediators in patients undergoing heart valve surgery under cardiopulmonary bypass (CPB) due to either infectious endocarditis or degenerative valvular heart disease. Specific attention will focus on the distinction between mediator release associated with infection and that resulting from CPB. Concomitantly identification and characterization of infectious pathogens in the circulation and in valvular samples will be carried out, together with the search for resistance-coding transcripts.
Exaggerated release of inflammatory mediators and endogenous vasoactive substances resulting
from the coincident infection and surgical stress plays a role in post-operative organ
failure and altered immune defense, thus contributing to unfavorable post-operative outcome.
Cardiopulmonary bypass (CPB) itself, even in the absence of IE, has been shown to modify
cytokine and vasoactive mediator release and may cause organ failure. Tracing of release
profiles of inflammatory cytokines and vasoactive mediators and their correlation with
postoperative organ dysfunction in cardiac surgery for IE or non-IE patients aims at the
assessment of the prognostic validity of these biomarkers and the evaluation of measures for
their pro-active clearance during the surgical intervention.
Induction of inflammatory mediators and their temporal release profile may vary depending on
the involved pathogens, which cannot be always identified by conventional techniques (blood
culture). Since it is conceivable that identification of the involved pathogen could explain
differences in cytokine secretory patterns in IE, use of advanced molecular technologies
(NGS) will support the clarification of such relations. Analysis of transcripts encoding
inflammatory and vasoactive mediators in blood cells will enable the surveillance of temporal
oscillations in their profiles during the observation time frame. Transcriptome analysis of
identified putative pathogens can also disclose features of antibiotic resistance.
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