Evaluation of Endothelial Dysfunction During Aortic Valvular Replacement by Bioprosthesis With and Without Extracorporeal Circulation
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).
Inclusion Criteria:

 -  Patient ≥ 18 years.

 -  Patient operated on aortic valvular replacement by bioprosthesis in surgery + CEC or
 TAVI

 -  Signed consent.

 -  Affiliation to Social Security

 Exclusion Criteria:

 -  Any other cardiac surgery

 -  Mechanical aortic valve replacement

 -  Permanent Ac / Fa.

 -  Pregnant woman.

 -  Curative anticoagulation (AVK, NANCO, heparin).

 -  Patient under tutelage or curatelle.

 -  Refusal of the patient.

 -  Participation in another study.

 -  Preoperative sepsis

 -  Minor or adult, under guardianship or curatorship