Mitroaortic valve replacement after aortic transapical approach failure in a patient with essential thrombocytosis

Abstract

There is a lack of published information about intraoperative and postoperative course of cardiac surgery in patients with essential thrombocytosis using cardiopulmonary bypass. Both risks of intraoperative thrombosis of extracorporeal conduits or uncontrolled postoperative bleeding are present, but its incidence and treatment are not well known. Here, we present a rare case of a patient with essential thrombocytosis, moderate mitral regurgitation and severe aortic stenosis who had a transapical aortic valve implantation with short-term severe periprosthetic regurgitation, who needed a mitroaortic replacement on cardiopulmonary bypass with no complications.

Emergency cardiac surgery and heparin resistance in a patient with essential thrombocythemia

“…A 22-year-old patient with ET was reported to undergo aortic valve replacement under CPB after his platelet count was reduced to 30.1 × 10 4 /μl by treatment with α-interferon [ 2 ]. A 64-year-old patient with ET was also reported to receive mitroaortic valve replacement under CPB after his platelet count was reduced to 30 × 10 4 /μl by treatment with hydroxyurea [ 3 ]. A 54-year-old patient with ET was reported to have cardiac artery bypass surgery under CPB with a high platelet count: 99 × 10 4 /μl [ 6 ].…”

“…There have been some case reports on patients with ET who underwent cardiac surgery under cardiopulmonary bypass (CPB). In two reports, the platelet count was reduced to a normal range using hydroxyurea or α-interferon before surgery was performed [ 2 , 3 ]. In the other reports, the platelet count was reduced by therapeutic plateletpheresis procedures preoperatively [ 4 , 5 ].…”

Cardiac surgery in patients with essential thrombocytosis: a report of three cases

“…With the diagnosis of essential thrombocytosis by the hematologist clinic, the patient administered hydroxyurea 100 mg/day for a week in order to reduce platelet count to 500.000/mm 3 . The patient underwent a successful three vessel on-pump coronary artery bypass grafting.…”

“…The platelet count was controlled using hydroxyurea 100 mg/day. The patient was dischaeged at 10 th day after the surgery with a platelet count of 300.000/mm 3 . At one-year follow-up, the patient showed no signs of thrombo-haemorrhagic and microvascular complications or angina.…”

“…There are no brief guidelines for patients with essential thrombocytosis undergoing cardiac surgery [2]. Patients with essential thrombocytosis may suffer intraoperative and postoperative thrombosis or postoperative uncontrollable bleeding, however incidence and therapeutic options of these risks are not well known [3]. Therefore, it is a matter of concern for cardiac surgeons to use cardiopulmonary bypass, heparin and anticoagulation in these patients.…”