Platelet reduction after stentless pericardial aortic valve replacement

Abstract

The aim of the study was to investigate the multi-factorial phenomenon of possible postoperative thrombocytopenia after aortic valve replacement (AVR) with the freedom SOLO (FS) bioprosthesis. A total of 254 patients underwent AVR with FS bioprosthesis in two cardiac surgery institutes. Platelet counts were measured preoperatively, immediately postoperatively and daily until the 11th day postoperatively. A multivariate generalized estimating equation model was applied to identify prognostic factors for whether or not patients postoperative platelet counts indicated no thrombocytopenia (platelet count >150 10(3)/mm(3)) versus at least mild thrombocytopenia (≤150 10(3)/mm(3)). Preoperatively, 11.2% of patients showed thrombocytopenia. The preoperative platelet count averaged 233.0 ± 83.2 10(3)/mm(3). The postoperative mean of platelet counts decreased daily reaching a minimum mean of 88.4 ± 58.8 10(3)/mm(3) 3 days after surgery and then started to increase, with the Day 11 postoperative mean of 173.3 ± 51.8 10(3)/mm(3). Compared with patients with no preoperative thrombocytopenia, patients with preoperative thrombocytopenia had an 8.69 increased odds of being in the group with postoperative platelet count <150 10(3)/mm(3). No major haemorrhagic or thromboembolic event was reported during hospitalization. This study shows that thrombocytopenia after the FS bioprosthesis replacement is a transient postoperative phenomenon, largely resolved within a few days after surgery, with no clinical consequences and haemodynamic dysfunction.

Predictors and clinical impact of pre‐existing and acquired thrombocytopenia following transcatheter aortic valve replacement

“…Clearly some mechanistic link exists between high‐velocity aortic lesions and TP. Not only have TP and hemolysis been reported with severe aortic valvular stenosis but others suggest that smaller pre‐operative valve areas increase the risk of having post‐operative TP . However, to date no systematic examination of native anatomic and/or dynamic aortic valvular properties has been undertaken.…”

Aortic Valve Replacement With the Stentless Freedom SOLO Bioprosthesis: A Systematic Review

“…Postoperative platelet counts were extracted from 11 studies (n ¼ 1,015) and compared with their preoperative value [22][23][24][25][26][27][28][29][30][31][32]. A control group was created using postoperative platelet counts from all other aortic valve prostheses included in these 11 studies (n ¼ 1,090).…”

“…On average, platelet counts in the other aortic prostheses were back to their preoperative level on postoperative day 9. Of the 11 articles shown in Figure 3, 10 concluded that thrombocytopenia was a numeric phenomenon with no adverse clinical events [22][23][24][25][26][27][28][29][30][31]. However, Hirnle and colleagues [32] reported 1 death in 29 Freedom SOLO patients due to thrombotic thrombocytopenic purpura.…”

“…That the homocysteic acid could be responsible for the thrombocytopenia has been suggested [28]; however, this hypothesis was rejected because studies of another bioprosthesis detoxified with the same solution did not reveal comparable thrombocytopenia [56], and rinsing the Freedom SOLO before implantation did not prevent thrombocytopenia [24]. Another hypothesis, that the thrombocytopenia was due to the different implantation technique, was also rejected [27]. O'Brien [4] previously used this technique with another bioprosthesis, and thrombocytopenia did not result.…”

Stentless Bioprosthess for Aortic Valve Replacement in Calcific Aortic Stenosis

“…It seems unrelated to the type of aortic bioprosthesis and I have not observed this phenomenon only in stentless pericardial valves, but also in different bioprostheses [68]. However, thrombocytopenia after implantation of the stentless pericardial xenografts can develop more common and becomes dangerous for the patient [69,70].…”