Thrombocytopenia after aortic valve replacement: comparison between mechanical and biological valves.

BACKGROUND AND AIM OF THE STUDY Concerns have been recently raised regarding the postoperative decrease in platelet count after aortic valve replacement (AVR). Thus, a retrospective analysis was conducted of patients after AVR with regards to postoperative platelet count. METHODS The data were analyzed from all patients undergoing AVR with (n = 829) or without (n = 1,230) coronary artery bypass grafting (CABG) at a single center between January 1998 and May 2009. The lowest (minimum) platelet count within the first five postoperative days was determined. RESULTS The patients received either an ATS mechanical prosthesis (ATS; n = 401), a St. Jude Medical mechanical prosthesis (SJM; n = 791), a Carpentier-Edwards Perimount bioprosthesis (CEP; n = 618), a Medtronic Freestyle stentless bioprosthesis (FRE; n = 213), or a Sorin Freedom Solo stentless bioprosthesis (SFS; n = 36). By using a multivariate linear regression model, the following independent risk factors for a lower postoperative platelet count were revealed: age, body surface area, active endocarditis, preoperative platelet count, duration of extracorporeal circulation, number of grafts, valve size, and units of transfused fresh-frozen plasma and red blood cells. On entering the type of prosthesis into the multivariate linear regression analysis, together with the other risk factors, patients with CEP and FRE valve prostheses had a lower minimum postoperative platelet count than those with mechanical prostheses (ATS and SJM). CONCLUSION Patients undergoing AVR with the Carpentier-Edwards Perimount bioprosthesis or a Medtronic Freestyle stentless bioprosthesis had a lower minimum platelet count within the first five postoperative days, compared to patients receiving ATS and St. Jude Medical mechanical prostheses. No differences were identified between the Sorin Freedom Solo and all other valve prostheses.

[1]  T. Caus,et al.  eComment: Lower postoperative platelet levels after aortic valve replacement with Freedom Solo prostheses: are there clinical repercussions? , 2008, Interactive cardiovascular and thoracic surgery.

[2]  L. Eckel,et al.  Differences in the recovery of platelet counts after biological aortic valve replacement. , 2008, Interactive cardiovascular and thoracic surgery.

[3]  C. Yerebakan,et al.  Severe thrombocytopenia occurs in patients after aortic valve replacement with the Freedom Solo stentless bioprosthesis , 2009 .

[4]  G. Kundt,et al.  Thrombocytopenia after aortic valve replacement with the Freedom Solo stentless bioprosthesis. , 2008, Interactive cardiovascular and thoracic surgery.

[5]  S. Hunter,et al.  Aortic valve replacement with the Sorin Pericarbon Freedom stentless valve: five-year follow up. , 2007, The Journal of heart valve disease.

[6]  W. Konertz,et al.  Operative technique and early hemodynamic results with the Freedom Solo valve. , 2006, The Journal of heart valve disease.

[7]  M. Cogné,et al.  Platelet activation after aortic prosthetic valve surgery. , 2005, Interactive cardiovascular and thoracic surgery.

[8]  J. Copeland,et al.  Thrombin activity and platelet microparticle formation are increased in type 2 diabetic platelets: a potential correlation with caspase activation. , 2002, Thrombosis research.

[9]  F. Mohr,et al.  Prospectively randomized evaluation of stentless versus conventional biological aortic valves: impact on early regression of left ventricular hypertrophy. , 1999, Circulation.

[10]  J. Pepper,et al.  Perioperative assessment of aortic homograft, Toronto stentless valve, and stented valve in the aortic position. , 1995, The Annals of thoracic surgery.