Two approaches-one phenomenon-thrombocytopenia after surgical and transcatheter aortic valve replacement

J Card Surg. 2020 Jun;35(6):1186-1194. doi: 10.1111/jocs.14547. Epub 2020 Apr 29.

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.

Keywords: TAVR; aortic valve replacement; cardiopulmonary bypass; platelet count; thrombocytopenia.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve / surgery*
  • Aortic Valve Stenosis / surgery*
  • Bioprosthesis / adverse effects*
  • Cardiopulmonary Bypass / adverse effects
  • Female
  • Heart Valve Prosthesis / adverse effects*
  • Heart Valve Prosthesis Implantation / adverse effects*
  • Humans
  • Male
  • Postoperative Complications / blood
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology*
  • Retrospective Studies
  • Risk Factors
  • Thrombocytopenia / blood
  • Thrombocytopenia / epidemiology
  • Thrombocytopenia / etiology*
  • Time Factors
  • Transcatheter Aortic Valve Replacement / adverse effects*