Thrombocytopenia After Surgical And Transcatheter Aortic Valve Replacement: Are There Any Differences?
Ferdinand Vogt1, Marco Moscarelli2, Francesco Pollari3, Dennis Eckner4, Christian Langhammer5, Steffen Pfeiffer3, Thomas Bertsch5, Matthias Pauschinger4, Theodor Fischlein3, Giuseppe Santarpino3.
1Paracelsus Medical University Nuremberg, Nuremberg, Germany, 2Anthea Hospital, GVM Care & Research, Bari, Cardiac Surgery, Italy, 3Paracelsus Medical University Nuremberg, Cardiac Surgery, Germany, 4Paracelsus Medical University Nuremberg, Cardiology, Germany, 5Paracelsus Medical University Nuremberg, Institue for Laboratory Medicine, Germany.
Postoperative thrombocytopenia after aortic valve replacement has been reported in the literature since many years, often associated with specific types of prosthetic valve models. Several mechanisms underlying this phenomenon have been hypothesized, however the direct cause remains a matter of controversial debate. To date, little is known about the cause and the clinical consequences of this phenomenon after TAVI.
We retrospectively analyzed postoperative platelet count - PLT (µ/L) of 1068 patients undergoing SAVR and 811 undergoing TAVR respectively. The majority of patients in the SAVR group received the Perceval valve (43.9%), whereas the most represented valves in the TAVR group were Sapien 3 & XT (33.8 and 36.3%). Intraprocedural mortality did not statistically differ between groups (0.5 vs. 1.3, SAVR vs. TAVR respectively, p=0.1)
With regard to SAVR subgroup analysis, there was a statistically significant difference in terms of platelets preservation between the tissue valve types (p<0.001), particularly with the Freedom-Solo valve showing a significant lower platelets count at different time point analysis; maybe due to a higher incidence of endocarditis in this group (17%). But there was a correlation with the cardiopulmonary bypass duration.
TAVR subgroup analysis, showed that the type of valve did not affect the platelets count along the time (p=0.13). TAVR group showed overall superior platelets preservation than the SAVR group (p<0.001), statistical significant at any time points from day 1 to day 8.
Thrombocytopenia is a phenomenon often registered in the first three days after implantation of a cardiac biological prostheses but recovers within one week. Its incidence seems to be more present in patients undergoing cardiac surgery than in patients undergoing TAVI. Although some “surgical” models are more susceptible to this phenomenon, the duration of extracorporeal circulation seems to be a determining factor for the onset of this phenomenon.
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