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Nakayama T, Nakamura Y, Shikata F, Ushijima M, Yasumoto Y, Yoshiyama D, Kuroda M, Sawa S, Tsuruta R, Furutachi A, Narita T, Ito Y. Thrombocytopenia Following Perceval Sutureless Aortic Valve Replacement in Asian Patients. Circ J 2024; 88:549-558. [PMID: 36709983 DOI: 10.1253/circj.cj-22-0587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND This study analyzed the safety and performance of the Perceval valve for aortic valve replacement (AVR) in patients at 1 year after undergoing aortic stenosis (AS) treatment, and its effect on significant declines in the platelet count during the immediate postoperative period. METHODS AND RESULTS Data were collected retrospectively for the initial 121 patients (median age 77 years; 47.1% females) who underwent Perceval sutureless AVR between May 2019 and July 2022. Implantation was successful in all (100%), with median cross-clamp and CPB times of 59 and 100 min, respectively. Postoperative thrombocytopenia (platelet count <50×103/μL) was noted in 80 (66.1%) patients. Multivariate analysis showed advanced age (>80 years), preoperative low platelet count (<200×103/μL), and a sternotomy approach as significant risk factors for postoperative thrombocytopenia. One (0.8%) patient died within 30 days after the procedure. The 2-year site-reported event rate was 14% (n=17) for all-cause mortality, 0.8% (n=1) for cardiac mortality, 4.1% (n=5) for stroke, and 1.7% (n=2) for endocarditis and valve-related reoperation; there were no instances of paravalvular leakage or structural valve deterioration. CONCLUSIONS Thrombocytopenia was common after Perceval sutureless AVR, although its impact was not significant. Although Perceval sutureless AVR was found to be a safe and effective option, preoperative assessment of potential bleeding should be performed and the Perceval valve should not be used for patients with a high bleeding risk.
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Affiliation(s)
- Taisuke Nakayama
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | | | - Fumiaki Shikata
- Department of Cardiovascular Surgery, Kitasato University School of Medicine
| | - Masaki Ushijima
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Yuto Yasumoto
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Daiki Yoshiyama
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Miho Kuroda
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Shintaro Sawa
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Ryo Tsuruta
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Akira Furutachi
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Takuya Narita
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Yujiro Ito
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
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Sugiura A, Treiling L, Al-Kassou B, Shamekhi J, Wilde N, Sinning JM, Zimmer S, Kuetting D, Oldenburg J, Poetzsch B, Nickenig G, Sedaghat A. Spleen Size and Thrombocytopenia After Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 157:85-92. [PMID: 34404506 DOI: 10.1016/j.amjcard.2021.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022]
Abstract
The pathophysiology of thrombocytopenia after transcatheter aortic valve implantation (TAVI) thrombocytopenia is still poorly understood. We assessed the association of spleen size with acquired thrombocytopenia in patients undergoing TAVI. We included 732 patients who underwent TAVI with new generation transcatheter heart valves (THVs) at our center from February 2016 to July 2019. We measured splenic volume index in consecutive patients derived from multidetector row computed tomographic datasets. Patients were stratified according to post-TAVI thrombocytopenia, which was defined as a decline in platelet count (DPC) ≥50% at nadir, and evaluated regarding baseline characteristics and outcome parameters. After the procedure, platelet counts declined from 212.9 ± 67.4 × 109/L at baseline to 138.8 ± 49.8 × 109/L at nadir after a median of 2 days (interquartile range [IQR] 2 to 3). Of all patients, 10.1% showed a DPC ≥50%. Compared with patients with DPC <50%, patients with DPC ≥50% had significantly lower splenic volume index (95.5 ml/m2 [IQR 78.0 to 123.7] vs 85.8 ml/m2 [IQR 71.4 to 102.6], p = 0.008). A multivariable analysis revealed that the splenic volume index was negatively associated with a DPC ≥50% (OR 0.89, 95% CI 0.82 to 0.97, p = 0.005), independent of the type of THV (balloon-expandable THV: OR 2.06, 95% CI 1.13 to 3.76, p = 0.02), major bleeding (OR 13.40, 95% CI 3.58 to 50.40, p <0.001), blood transfusion (OR 3.63, 95% CI 1.54 to 8.56, p = 0.003), or postprocedural paravalvular leakage ≥moderate (OR 5.48, 95% CI 1.23 to 24.40, p = 0.03). Furthermore, DPC ≥50% was independently associated with 1-year mortality (HR 3.36, 95% CI 1.66 to 6.81, p <0.001). In conclusion, acquired thrombocytopenia remains prevalent in modern TAVI patients. Spleen size appears to be associated with the occurrence of thrombocytopenia after TAVI, which is independently correlated with 1-year mortality.
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Affiliation(s)
- Atsushi Sugiura
- Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Louisa Treiling
- Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Baravan Al-Kassou
- Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Jasmin Shamekhi
- Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Nihal Wilde
- Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Jan-Malte Sinning
- Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Daniel Kuetting
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institut für Experimentelle Hämatologie und Transfusionsmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - Bernd Poetzsch
- Institut für Experimentelle Hämatologie und Transfusionsmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - Georg Nickenig
- Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
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Squiccimarro E, Jiritano F, Serraino GF, ten Cate H, Paparella D, Lorusso R. Quantitative and Qualitative Platelet Derangements in Cardiac Surgery and Extracorporeal Life Support. J Clin Med 2021; 10:jcm10040615. [PMID: 33561947 PMCID: PMC7914426 DOI: 10.3390/jcm10040615] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 01/19/2023] Open
Abstract
Thrombocytopenia and impaired platelet function are known as intrinsic drawbacks of cardiac surgery and extracorporeal life supports (ECLS). A number of different factors influence platelet count and function including the inflammatory response to a cardiopulmonary bypass (CPB) or to ECLS, hemodilution, hypothermia, mechanical damage and preoperative treatment with platelet-inhibiting agents. Moreover, although underestimated, heparin-induced thrombocytopenia is still a hiccup in the perioperative management of cardiac surgical and, above all, ECLS patients. Moreover, recent investigations have highlighted how platelet disorders also affect patients undergoing biological prosthesis implantation. Though many hypotheses have been suggested, the mechanism underlying thrombocytopenia and platelet disorders is still to be cleared. This narrative review aims to offer clinicians a summary of their major causes in the cardiac surgery setting.
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Affiliation(s)
- Enrico Squiccimarro
- Department of Cardiac Surgery, Mater Dei Hospital, 70125 Bari, Italy;
- Department of Emergency and Organ Transplant (DETO), University of Bari, 70125 Bari, Italy
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), 6229HX Maastricht, The Netherlands;
| | - Federica Jiritano
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), 6229HX Maastricht, The Netherlands;
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy;
- Correspondence:
| | - Giuseppe Filiberto Serraino
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy;
| | - Hugo ten Cate
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, D-55131 Mainz, Germany;
- Thrombosis Center Maastricht, Maastricht University Medical Center (MUMC), 6229HX Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), 6229HX Maastricht, The Netherlands
| | - Domenico Paparella
- Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, 70125 Bari, Italy;
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), 6229HX Maastricht, The Netherlands;
- Cardiovascular Research Institute Maastricht (CARIM), 6229HX Maastricht, The Netherlands
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Stegmeier P, Schlömicher M, Stiegler H, Strauch JT, Bechtel JM. Thrombocytopenia after implantation of the Perceval S aortic bioprosthesis. J Thorac Cardiovasc Surg 2020; 160:61-68.e8. [DOI: 10.1016/j.jtcvs.2019.07.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 06/25/2019] [Accepted: 07/10/2019] [Indexed: 01/07/2023]
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Movileanu I, Pepa M, Cândea M, Ureche C. Heart valve mechanical prosthesis: The perfect match until it is not - A case report. Exp Ther Med 2020; 20:2481-2483. [PMID: 32765738 DOI: 10.3892/etm.2020.8959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/01/2020] [Indexed: 12/12/2022] Open
Abstract
Primary immune thrombocytopenia (ITP), formerly known as idiopathic thrombocytopenia, is defined by a reduced platelet count <50x109 and is clinically manifested through signs and symptoms such as bleeding, ecchymosis and petechiae. Its coexistence with the implantation of the mechanical valves and the necessity of anticoagulation creates an additional risk of bleeding. Although mechanical valves are indispensable in prolonging and improving the quality of life in patients with valvular heart disease, in the context of an additional bleeding risk factor, their presence could represent a threat to life exposing the patient to major complications and leading to death. The purpose of this case report is to discuss the disadvantages and possible fatal complications of the association between mechanical valves and severe thrombocytopenia. A possible solution to these downsides could be found in the future search in regenerative medicine and tissue engineering of heart valves resulting in products that do not require anticoagulation and do not pose a threat to patients with thrombocytopenia.
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Affiliation(s)
- Ionela Movileanu
- First Cardiology Department, Emergency Institute of Cardiovascular Diseases and Transplant, 540136 Târgu Mure?, Romania
| | - Miruna Pepa
- First Cardiology Department, Emergency Institute of Cardiovascular Diseases and Transplant, 540136 Târgu Mure?, Romania
| | - Marcela Cândea
- First Internal Medical Department, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Târgu Mure?, Romania
| | - Corina Ureche
- First Internal Medical Department, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Târgu Mure?, Romania
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Vogt F, Moscarelli M, Pollari F, Kalisnik JM, Pfeiffer S, Fittkau M, Sirch J, Pförringer D, Jessl J, Eckner D, Ademaj F, Bertsch T, Langhammer C, Fischlein T, Santarpino G. Two approaches-one phenomenon-thrombocytopenia after surgical and transcatheter aortic valve replacement. J Card Surg 2020; 35:1186-1194. [PMID: 32349178 DOI: 10.1111/jocs.14547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROPUND AND AIM Postoperative thrombocytopenia after surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) and aggravating causes were the aim of this retrospective study. METHODS Data of all patients treated with SAVR (n = 1068) and TAVR (n = 816) due to severe aortic valve stenosis was collected at our center from 2010 to 2017. Preprocedural and postprocedural values were collected from electronic patient records. RESULTS There was a significant drop in platelets in both groups, the TAVR group showed overall superior platelet preservation compared to the AVR group (P < .001). In the SAVR subgroup analysis, a significant difference in platelet preservation was observed between the valve types (P < .001), particularly with the Freedom SOLO valve. In the TAVR subgroup analysis, the valve type did not influence platelet count (PLT) reduction (P = .13). In the SAVR subgroup analyses, PLT was found to be worsened with cardiopulmonary bypass (CPB) duration. CONCLUSION Thrombocytopenia frequently occurs after implantation of a biological heart valve prosthesis, with a higher frequency observed in patients after cardiac surgery rather than TAVR. Although some surgical bioprosthetic models are more susceptible to this phenomenon, CPB duration seems to be a major determinant for the development of postoperative thrombocytopenia.
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Affiliation(s)
- Ferdinand Vogt
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Marco Moscarelli
- Department of Cardiovascular Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Francesco Pollari
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Jurij M Kalisnik
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Steffen Pfeiffer
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Matthias Fittkau
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Joachim Sirch
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Dominik Pförringer
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Jürgen Jessl
- Department of Cardiology, Paracelsus Medical University, Nuremberg, Germany
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University, Nuremberg, Germany
| | - Fadil Ademaj
- Department of Cardiology, Paracelsus Medical University, Nuremberg, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Christian Langhammer
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Theodor Fischlein
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Giuseppe Santarpino
- Cardiac Surgery Unit, Department of Experimental and Clinical Science, Magna Graecia, University of Catanzaro, Catanzaro, Italy.,Paracelsus Medical University, Nuremberg, Germany
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7
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Commentary: Perceval S bioprosthesis valve and platelets: The thrombocytopenia is behind the corner and the mystery continues. J Thorac Cardiovasc Surg 2019; 160:69-70. [PMID: 31619333 DOI: 10.1016/j.jtcvs.2019.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 02/02/2023]
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Peri-procedural thrombocytopenia after aortic bioprosthesis implant: A systematic review and meta-analysis comparison among conventional, stentless, rapid-deployment, and transcatheter valves. Int J Cardiol 2019; 296:43-50. [PMID: 31351790 DOI: 10.1016/j.ijcard.2019.07.056] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/14/2019] [Accepted: 07/15/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Thrombocytopenia has been shown to occur soon after surgical biological aortic valve replacement (AVR), and recently reported also after transcatheter valve implantation (TAVI). The mechanism underlying this phenomenon is still unknown, and its clinical impact on the peri-operative outcome has been poorly investigated. METHODS A systematic review and a meta-analysis of all available studies reporting data about peri-procedural thrombocytopenia on isolated bio-AVR, comparing rapid-deployment (RDV), stentless (stentless-AVR), and TAVI vs. stented (stented-AVR) valves, have been performed. RESULTS Fifteen trials (2.163 patients) were included in the meta-analysis. Perioperative platelet reduction ranged from 35% to 55% in stented-AVR, from 60% to 77% in stentless-AVR, from 53% to 60% in RDV, and from to 21% to 72% in TAVI (apparently, balloon-expandable valves more frequently associated to thrombocytopenia). Stented-AVR required more red blood cells transfusion than stentless-AVR (P < 0.0001), whereas no difference has been found between RDV and stented-AVR. Platelet transfusion rate was very low in all surgical groups. No difference has been found in RDV and stentless-AVR vs. stented-AVR, in terms of reoperation for bleeding, and length-of-intensive care unit or hospital stay. CONCLUSIONS Thrombocytopenia-related major adverse events were mainly reported in TAVI patients, whereas clinically meaningless in surgical patients. Transient peri-procedural thrombocytopenia is common after bio-AVR, regardless of prosthesis's type or implant modality. It should receive appropriate monitoring and focused investigations.
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Stanger O, Grabherr M, Gahl B, Longnus S, Meinitzer A, Fiedler M, Tevaearai H, Carrel T. Thrombocytopaenia after aortic valve replacement with stented, stentless and sutureless bioprostheses. Eur J Cardiothorac Surg 2019; 51:340-346. [PMID: 28186236 DOI: 10.1093/ejcts/ezw295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/27/2016] [Accepted: 07/29/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Olaf Stanger
- Clinic for Cardiovascular Surgery, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Michael Grabherr
- Clinic for Cardiovascular Surgery, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Brigitta Gahl
- Clinic for Cardiovascular Surgery, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Sarah Longnus
- Clinic for Cardiovascular Surgery, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Andreas Meinitzer
- Department of Laboratory Medicine, University Hospital, Auenbrugger University, Graz, Austria
| | - Martin Fiedler
- Center for Laboratory Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Hendrik Tevaearai
- Clinic for Cardiovascular Surgery, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Thierry Carrel
- Clinic for Cardiovascular Surgery, Inselspital, University Hospital Bern, Bern, Switzerland
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Souza RCD, Paim L, Viotto G, Aprigio J, Araújo LL, Ribeiro H, Sampaio RO, Tarasoutchi F, Pomerantzeff PMA, Palma JH, Jatene FB. Thrombocytopenia After Transcatheter Valve-in-Valve Implantation: Prognostic Marker or Mere Finding? Braz J Cardiovasc Surg 2019; 33:362-370. [PMID: 30184033 PMCID: PMC6122764 DOI: 10.21470/1678-9741-2018-0078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 04/27/2018] [Indexed: 11/25/2022] Open
Abstract
Objective To analyze the behavior of platelets after transcatheter valve-in-valve
implantation for the treatment of degenerated bioprosthesis and how they
correlate with adverse events upon follow-up. Methods Retrospective analysis of 28 patients who received a valve-in-valve implant,
5 in aortic, 18 in mitral and 5 in tricuspid positions. Data were compared
with 74 patients submitted to conventional redo valvular replacements during
the same period, and both groups' platelet curves were analyzed. Statistical
analysis was conducted using the IBM SPSS Statistics(r) 20 for Windows. Results All patients in the valve-in-valve group developed thrombocytopenia, 25%
presenting mild (<150.000/µL), 54% moderate
(<100.000/µL) and 21% severe (<50.000/µL)
thrombocytopenia. The platelet nadir was on the 4th postoperative
day for aortic ViV, 2nd for mitral and 3rd for
tricuspid patients, with the majority of patients recovering regular
platelet count. However, the aortic subgroup comparison between
valve-in-valve and conventional surgery showed a statistically significant
difference from the 7th day onwards, where valve-in-valve
patients had more severe and longer lasting thrombocytopenia. This, however,
did not translate into a higher postoperative risk. In our study population,
postoperative thrombocytopenia did not correlate with greater occurrence of
adverse outcomes and only normal preoperative platelet count could
significantly predict a postoperative drop >50%. Conclusion Although thrombocytopenia is an extremely common finding after valve-in-valve
procedures, the degree of platelet count drop did not correlate with greater
incidence of postoperative adverse outcomes in our study population.
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Affiliation(s)
- Renato C de Souza
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Leonardo Paim
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Guilherme Viotto
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Joaquim Aprigio
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Lucas L Araújo
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Henrique Ribeiro
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Roney O Sampaio
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Flavio Tarasoutchi
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Pablo M A Pomerantzeff
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - José Honório Palma
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Fabio B Jatene
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
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Mujtaba SS, Ledingham S, Shah AR, Schueler S, Clark S, Pillay T. Thrombocytopenia After Aortic Valve Replacement: Comparison Between Sutureless Perceval S Valve and Perimount Magna Ease Bioprosthesis. Braz J Cardiovasc Surg 2019; 33:169-175. [PMID: 29898147 PMCID: PMC5985844 DOI: 10.21470/1678-9741-2017-0157] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/06/2017] [Indexed: 12/31/2022] Open
Abstract
Introduction The incidence of postoperative thrombocytopenia after aortic valve
replacement (AVR) with the Perceval S Sutureless bioprosthesis remains
unclear. The aim of this study was to report thrombocytopenia associated
with the use of sutureless AVR. Methods The data was collected retrospectively for patients who had isolated AVR with
sutureless Perceval S valve (Group A: 72 patients) and was compared with
patients who underwent isolated sutured AVR with Perimount Magna Ease
Bioprosthesis (Group B: 101 patients) in our institution between June 2014
and January 2017. Results Cardiopulmonary bypass and cross-clamp time were significantly shorter in
group A. Maximum drop in platelet count was 58% mean (day 2.3) in group A
versus 44% mean (day 1.7) in group B
(P=0.0001). Absolute platelet count on postoperative
day 1-6 in group A was significantly less than in group B
(P≤0.05). Platelet count recovered to
preoperative value in 44% patients in group B versus only
in 26% patients in group A at discharge (P=0.018). Moderate
thrombocytopenia occurs more often in group A (41% vs. 26%)
(P=0.008) while severe thrombocytopenia (<50 x
109) was observed in 6% in group A but never in group B.
Platelets (P=0.007) and packed red blood cells
(P=0.009) transfusion was significantly higher in the
group A. Conclusion The implantation of sutureless Perceval aortic valves was associated with a
significant drop in platelet count postoperatively with slow recovery and
higher platelets and packed red blood cells transfusion requirements. A
prospective randomised trial is needed to confirm our findings.
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Affiliation(s)
- Syed Saleem Mujtaba
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
| | - Simon Ledingham
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
| | - Asif Raza Shah
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
| | - Stephan Schueler
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
| | - Stephen Clark
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
| | - Thasee Pillay
- Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, United Kingdom of Great Britain and Northern Ireland
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Zhu Q, Liu X, He W, He Y, Tang M, Sun Y, Xu X, Shi K, Kong H, Jiang J, Chen L, Chen J, Hu P, Xu Q, Wang J. Predictors of Thrombocytopenia after Self-Expandable Transcatheter Aortic Valve Replacement: A Single-Center Experience from China. Cardiology 2018; 139:151-158. [PMID: 29353286 DOI: 10.1159/000484627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 10/04/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The importance of thrombocytopenia (TP) has been discussed previously. However, data are still limited, especially on predictors of TP. We sought to investigate predictors of TP after transcatheter aortic valve replacement (TAVR), in particular, clinically significant TP. METHODS We reviewed a total of 123 consecutive patients undergoing TAVR in our medical center. They were stratified into 3 groups according to the nadir platelet count post-TAVR: no/mild TP, moderate TP, and severe TP. Clinically significant TP, also known as major TP, was defined as moderate-to-severe TP (a nadir platelet count <100 × 109/L and a >50% decrease in platelet count). RESULTS Baseline platelet, baseline hemoglobin, general anesthesia (GA), valve malpositioning and post-TAVR left ventricular ejection fraction were found to be predictors of post-TAVR nadir platelet count. Major TP was associated with a higher risk of major bleeding (OR 3.524, 95% CI 1.546-8.031) and 1-month mortality (OR 11.226, 95% CI 1.208-104.328). Age (OR 1.110, 95% CI 1.014-1.215) and GA (OR 6.494, 95% CI 2.058-20.408) were predictors of major TP. CONCLUSION Post-TAVR nadir platelet count can be predicted based on baseline and procedural data. Old age and GA contribute to clinically significant TP.
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Affiliation(s)
- Qifeng Zhu
- Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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Mitrosz M, Chlabicz M, Hapaniuk K, Kaminski KA, Sobkowicz B, Piszcz J, Dobrzycki S, Musial WJ, Hirnle T, Tycinska AM. Thrombocytopenia associated with TAVI-The summary of possible causes. Adv Med Sci 2017; 62:378-382. [PMID: 28550795 DOI: 10.1016/j.advms.2017.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/21/2017] [Accepted: 04/20/2017] [Indexed: 12/20/2022]
Abstract
Thrombocytopenia (TP) following transcatheter aortic valve implantation (TAVI) procedure is a common phenomenon but the underlying mechanisms are neither well known nor described. Postinterventional severe TP is related to worse early and late outcome. Moreover, the statement of enhanced platelet and coagulation activation might justify even stronger antiplatelet and anticoagulation therapy following TAVI procedure. Thus, the examination of the pathomechanisms responsible for TP post TAVI seems to be crucial. Several hypotheses have been raised. TP can be caused by insufficient production or impaired platelet renewal. On the other hand, increased platelet activation, consumption and destruction might also be responsible for TP. These findings, mostly related to the procedure alone, need further investigation. Here, we summarize the potential multifactorial causes of post TAVI thrombocytopenia.
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Stanger O, Gahl B, Grabherr M, Krausler R, Longnus S, Meinitzer A, Cadamuro J. Freedom SOLO-Associated Thrombocytopaenia is Valve-Dependent and Not Due to In Vitro Pseudothrombocytopaenia. Heart Lung Circ 2017; 26:268-275. [DOI: 10.1016/j.hlc.2016.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/30/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
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Tissue valve, nitinol stent, or storage solution? The mystery still goes on. J Thorac Cardiovasc Surg 2016; 152:1633-1634. [PMID: 27593546 DOI: 10.1016/j.jtcvs.2016.07.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 07/30/2016] [Indexed: 11/22/2022]
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Thalmann M, Grubitzsch H, Matschke K, Glauber M, Tan E, Francois K, Amorim MJ, Hensens AG, Cesari F, Feyrer R, Diegeler A, Veit F, Repossini A. A European Multicenter Study of 616 Patients Receiving the Freedom Solo Stentless Bioprosthesis. Ann Thorac Surg 2015; 101:100-8. [PMID: 26443880 DOI: 10.1016/j.athoracsur.2015.06.096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 06/20/2015] [Accepted: 06/26/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the safety and performance of the Freedom Solo valve in aortic valve replacement by clinical and hemodynamic outcomes. METHODS Six hundred sixteen patients underwent aortic valve replacement in 18 European centers; mean age was 74.5 ± 5.9 years, 54.1% of the patients were male, and concomitant procedures were performed in 43.2% of the patients. The majority (69%) of the implanted sizes were 23 mm and 25 mm. RESULTS At 1 year, overall survival was 94.0%, whereas freedom from valve-related death was 98.6%. There were 9 (1.5%) early (≤ 30 days) and 27 (4.4%) late (>30 days) deaths. Early and late valve-related mortality was 0.3% (n = 2) and 1.1% (n = 7), respectively. Freedom from explant was 97.6%; 10 valves were explanted for endocarditis and 4 for paravalvular leak. There were 10 (1.6%) early and 5 (0.8%) late strokes. Atrioventricular block requiring pacemaker implant occurred in 8 (1.3%) and 1 (0.2%) patients in the early and late postoperative period, respectively. Thrombocytopenia was seen in 27 cases (4.4%) in the early postoperative period. Preoperatively, 93.8% of patients were in New York Heart Association functional classes II through IV, whereas at 1 year 96.9% of patients were in New York Heart Association functional classes I and II. At 1-year follow-up, mean and peak pressure gradients were 7.2 and 14.6 mm Hg, respectively. Indexed left ventricular mass decreased by 12% from 138 g/m(2) at discharge to 122 g/m(2) at 1 year. CONCLUSIONS At 1-year follow-up after Freedom Solo implantation, we found acceptable clinical results with low mortality and morbidity and good hemodynamic performance, confirming safety and effectiveness in this multicenter experience.
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Affiliation(s)
| | | | | | | | - Erwin Tan
- Catharina Hospital, Eindhoven, The Netherlands
| | | | | | | | | | | | | | | | - Alberto Repossini
- Cardiac Surgery, University of Brescia, Spedali Civili, Brescia, Italy
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Wollersheim LW, Li WW, Bouma BJ, Repossini A, van der Meulen J, de Mol BA. Aortic Valve Replacement With the Stentless Freedom SOLO Bioprosthesis: A Systematic Review. Ann Thorac Surg 2015; 100:1496-504. [DOI: 10.1016/j.athoracsur.2015.06.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 04/22/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
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18
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Stanger O, Bleuel I, Gisler F, Göber V, Reineke S, Gahl B, Aymard T, Englberger L, Carrel T, Tevaearai H. The Freedom Solo pericardial stentless valve: Single-center experience, outcomes, and long-term durability. J Thorac Cardiovasc Surg 2015; 150:70-7. [DOI: 10.1016/j.jtcvs.2015.01.060] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/08/2015] [Accepted: 01/24/2015] [Indexed: 11/30/2022]
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Heimansohn D, Roselli EE, Thourani VH, Wang S, Voisine P, Ye J, Dabir R, Moon M. North American trial results at 1 year with the Sorin Freedom SOLO pericardial aortic valve. Eur J Cardiothorac Surg 2015; 49:493-9; discussion 499. [PMID: 26003957 DOI: 10.1093/ejcts/ezv169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 03/25/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES A North American prospective, 15-centre Food and Drug Administration (FDA) valve trial was designed to assess the safety and effectiveness of the Freedom SOLO stentless pericardial aortic valve in the treatment of surgical aortic valve disease. METHODS Beginning in 2010, 251 patients (mean: 74.7 ± 7.5 years), were recruited in the Freedom SOLO aortic valve trial. One hundred eighty-nine patients have been followed for at least 1 year and are the basis for this review. Preoperatively, 54% of patients had NYHA functional class III or IV symptoms, and the majority of patients had a normal ejection fraction (EF) (median EF = 61%). Concomitant procedures were performed in 61.9% of patients, with coronary artery bypass grafting (CABG) (48.7%) being the most common followed by a MAZE procedure (13.7%). Reoperations were performed in 8.5% of patients in the study. RESULTS The entire cohort of 251 patients enrolled had 7 deaths prior to 30 days, 2 of which were valve-related (aspiration pneumonia and sudden death) and 5 were not valve-related. There were 11 deaths after 30 days, 1 valve-related (unknown cardiac death) and 10 not valve-related. Five valves were explanted, 3 early (endocarditis, acute insufficiency and possible root dissection) and 2 late (endocarditis). Thirty-day adverse events include arrhythmias requiring permanent pacemaker (4.2%), thromboembolic events (3.7%) and thrombocytopenia (7.4%). One-year follow-up of all 189 patients demonstrated mean gradients for valve sizes 19, 21, 23, 25 and 27 mm of 11.7, 7.8, 6.3, 4.6 and 5.0 mmHg, respectively. Effective orifice areas for the same valve sizes were 1.2, 1.3, 1.6, 1.8 and 1.9 cm(2), respectively. Ninety-six percent of patients (181/189) were in NYHA class I or II at the 1-year follow-up. CONCLUSIONS The Freedom SOLO stentless pericardial aortic valve demonstrated excellent haemodynamics and a good safety profile out to the 1 year of follow-up.
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Affiliation(s)
- David Heimansohn
- Department of Cardiothoracic Surgery, St Vincent Heart Center, Indianapolis, IN, USA
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Vinod H Thourani
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA
| | - Shaohua Wang
- Department of Cardiothoracic Surgery, University of Alberta, Edmonton, AB, USA
| | | | - Jian Ye
- St. Paul's Hospital, Vancouver, BC, Canada
| | - Reza Dabir
- Great Lakes Cardiovascular and Thoracic Surgeons, Dearborn, MI, USA
| | - Michael Moon
- Mazankowski Alberta Heart Institute, Edmonton, AB, Canada
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Grubitzsch H, Wang S, Matschke K, Glauber M, Heimansohn D, Tan E, Francois K, Thalmann M. Clinical and haemodynamic outcomes in 804 patients receiving the Freedom SOLO stentless aortic valve: results from an international prospective multicentre study†. Eur J Cardiothorac Surg 2014; 47:e97-104. [DOI: 10.1093/ejcts/ezu471] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Flaherty MP, Mohsen A, Moore JB, Bartoli CR, Schneibel E, Rawasia W, Williams ML, Grubb KJ, Hirsch GA. Predictors and clinical impact of pre-existing and acquired thrombocytopenia following transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2014; 85:118-29. [PMID: 25204308 DOI: 10.1002/ccd.25668] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 07/30/2014] [Accepted: 09/06/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Data are limited regarding transcatheter aortic valve replacement (TAVR)-related thrombocytopenia (TP). We sought to thoroughly characterize the presence, clinical impact, and severity of TP associated with TAVR. METHODS AND RESULTS Data were collected from 90 patients who underwent TAVR using the Edwards SAPIEN valve (59 TF, 29 TA, 2 Tao). Platelet counts were evaluated peri-procedurally and for 8 days following TAVR. Platelet levels were compared and patients were divided into a no TP (No-TP) group 1, acquired (new) TP (NTP) group 2, pre-existing (pre-TAVR) TP (PTP) group 3, and further stratified based on the severity of TP: mild (M) TP (100-149 × 10(3) cell/µL) and moderate-severe (MS) TP (<100 × 10(3) cell/µL). Pre-TAVR point prevalence and post-TAVR incidence of TP were 40% and 79%, respectively (P < 0.001); nadir platelet count in all groups occurred day 4 post-TAVR. Baseline predictors for developing MS TP in groups 2-3 included baseline TP, leaner body mass, smaller pre-procedural aortic valve area, higher peak aortic jet velocity, and worsening baseline renal function. Development of "major" TP (nadir platelet count <100 × 103 cell/µL, ≥50% decrease) predicted a higher risk of major vascular complications (OR 2.78 [95% CI, 1.58-3.82]) and major bleeding (OR 3.18 [95% CI, 1.33-5.42]) in group 3. CONCLUSION TAVR-related TP is predictable and classification by PTP and TP severity prior to TAVR allows for better risk stratification in predicting in-hospital clinical outcomes. Major TP in the presence of worsening TP is predictable and is associated with worse clinical outcomes. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Michael P Flaherty
- Division of Cardiovascular Medicine, University of Louisville School of Medicine and Jewish Hospital Rudd Heart and Lung Institute, Louisville, Kentucky
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Jilaihawi H, Doctor N, Chakravarty T, Kashif M, Mirocha J, Cheng W, Lill M, Nakamura M, Gheorghiu M, Makkar RR. Major thrombocytopenia after balloon-expandable transcatheter aortic valve replacement: Prognostic implications and comparison to surgical aortic valve replacement. Catheter Cardiovasc Interv 2014; 85:130-7. [DOI: 10.1002/ccd.25430] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 01/28/2014] [Accepted: 02/08/2014] [Indexed: 12/28/2022]
Affiliation(s)
- Hasan Jilaihawi
- Cedars-Sinai Heart Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Niraj Doctor
- Cedars-Sinai Heart Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Tarun Chakravarty
- Cedars-Sinai Heart Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Mohammad Kashif
- Cedars-Sinai Heart Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - James Mirocha
- Cedars-Sinai Heart Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Wen Cheng
- Cedars-Sinai Heart Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Michael Lill
- Cedars-Sinai Heart Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Mamoo Nakamura
- Cedars-Sinai Heart Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Mitch Gheorghiu
- Cedars-Sinai Heart Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Raj R. Makkar
- Cedars-Sinai Heart Institute; Cedars-Sinai Medical Center; Los Angeles California
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Pozzoli A, De Maat GE, Hillege HL, Boogaard JJ, Natour E, Mariani MA. Severe Thrombocytopenia and Its Clinical Impact After Implant of the Stentless Freedom Solo Bioprosthesis. Ann Thorac Surg 2013; 96:1581-6. [DOI: 10.1016/j.athoracsur.2013.06.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 06/06/2013] [Accepted: 06/10/2013] [Indexed: 10/26/2022]
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Miceli A, Gilmanov D, Murzi M, Parri MS, Cerillo AG, Bevilacqua S, Farneti PA, Glauber M. Evaluation of platelet count after isolated biological aortic valve replacement with Freedom Solo bioprosthesis. Eur J Cardiothorac Surg 2012; 41:69-73. [PMID: 21664141 DOI: 10.1016/j.ejcts.2011.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The risk of thrombocytopenia in patients undergoing aortic valve replacement (AVR) with the Freedom Solo (FS) bioprosthesis is controversial. The aim of our study was to evaluate the postoperative evolution of platelet count and function after AVR in patients undergoing isolated biological AVR with FS. METHODS Between May 2005 and June 2010, 322 patients underwent isolated biological AVR. Of these, 116 patients received FS and were compared with 206 patients who received biological valves. Platelet count, mean platelet volume (MPV), and platelet distribution width (PDW) were evaluated at baseline (T0), first (T1), second (T2), and fifth (T3) postoperative days, respectively. RESULTS Overall in-hospital mortality was 1.5% with no difference between the two groups. Thirty-seven (11.5%) patients developed thrombocytopenia. FS implantation was associated with a higher incidence of thrombocytopenia compared with the control group (24.1% vs 4.4%, p<0.0001). Patients in the FS group showed a lower platelet count than the control group at T1 (99.4±38×10(3) μl(-1) vs 122.5±41.6×10(3) μl(-1), p<0.001), T2 (79.7±36.3×10(3) μl(-1) vs 122.5±43.3×10(3) μl(-1), p<0.001) and T3 (86.6±57.4×10(3) μl(-1) vs 158.4±55.8×10(3) μl(-1), p<0.001). Moreover, the FS group also had a higher MPV (11.6±0.9 fl vs 11±1 fl, p<0.001) and higher PDW (15.1±2.3 fl vs 13.9±2.1 fl, p<0.001) at T3. In a multivariable analysis, FS (p<0.0001), body surface area (p<0.0001), cardiopulmonary bypass time (p=0.003), and lower preoperative platelet counts (p=0.006) were independent predictors of thrombocytopenia. CONCLUSIONS The FS valve might increase the risk of thrombocytopenia and platelet activation, in the absence of adverse clinical events. Prospective randomized studies on platelet function need to confirm our data.
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Affiliation(s)
- Antonio Miceli
- Department of Cardiothoracic Surgery, Fondazione G. Monasterio CNR-Regione Toscana, Via Aurelia Sud, 54100 Massa, Italy.
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Repossini A, Bloch D, Muneretto C, Piccoli P, Bisleri G, Beholz S. Platelet reduction after stentless pericardial aortic valve replacement. Interact Cardiovasc Thorac Surg 2012; 14:434-8. [PMID: 22279119 DOI: 10.1093/icvts/ivr069] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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.
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Affiliation(s)
- Alberto Repossini
- Department of Cardiac Surgery, University of Brescia, Brescia, Italy.
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Flameng W, Herregods MC, Hermans H, Van der Mieren G, Vercalsteren M, Poortmans G, Van Hemelrijck J, Meuris B. Effect of sutureless implantation of the Perceval S aortic valve bioprosthesis on intraoperative and early postoperative outcomes. J Thorac Cardiovasc Surg 2011; 142:1453-7. [DOI: 10.1016/j.jtcvs.2011.02.021] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 02/07/2011] [Accepted: 02/18/2011] [Indexed: 10/18/2022]
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Freedom Solo Stentless Aortic Valve: Quantitative and Qualitative Assessment of Thrombocytopenia. Ann Thorac Surg 2011; 92:1935. [DOI: 10.1016/j.athoracsur.2011.06.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 05/25/2011] [Accepted: 06/14/2011] [Indexed: 11/30/2022]
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Thrombocytopenia After Sorin Freedom Solo Valve Implant. Ann Thorac Surg 2011; 91:1307. [DOI: 10.1016/j.athoracsur.2010.09.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 09/21/2010] [Accepted: 09/21/2010] [Indexed: 11/22/2022]
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Santarpino G, Pfeiffer S, Fischlein T. Thrombocytopenia After Freedom Solo: The Mystery Goes On. Ann Thorac Surg 2011; 91:330. [DOI: 10.1016/j.athoracsur.2010.06.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 06/03/2010] [Accepted: 06/10/2010] [Indexed: 11/25/2022]
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