Thrombocytopenia after aortic valve replacement with the Freedom Solo stentless bioprosthesis

Abstract

Stentless bioprostheses have been considered to achieve superior hemodynamics over stented bioprostheses for aortic valve replacement with improved long-term performance. We observed severe thrombocytopenia in patients who received the Sorin Freedom Solo aortic stentless pericardial bioprosthesis within the first days after implantation. Absolute and relative platelet counts within 2 weeks after implantation of either a stentless (Sorin Freedom Solo) or a stented (Sorin Mitroflow) bovine pericardial bioprosthesis were compared in a matched-pairs analysis in 40 patients. Except the preoperative values, absolute platelet count was higher at all time points in the Mitroflow group. In the Mitroflow group, the mean platelet count moderately dropped to a minimum of 60% of the initial value on POD 3 and fully recovered by POD 8. In the Freedom Solo group, platelet loss was significantly more severe (minimum relative value 25% on POD 4) with no recovery during follow-up (60% on POD 13). Eight patients of the Freedom Solo group experienced a critical platelet drop towards <20% of their initial values, in five of them absolute numbers decreased below 30,000/microl. No bleeding complications or other morbidity occurred. Attention should focus on the platelet count after implantation of the Freedom Solo bioprosthesis, especially in patients who are supposed to receive platelet inhibitors. However, the described phenomenon remains unexplained.

Hemodynamics of Pericardial Aortic Valves: Contemporary Stented versus Stentless Valves in a Matched Comparison

“…A repeatedly reported complication after implantation of the SFS is thrombocytopenia. 12,13) In our matched study 17) Considering the geometric dimensions of the LDP and the SFS ( Table 1), with a higher orifice diameter of the SFS in the same labeled valve size (3 mm), one would expect a distinct advantage of the stentless valve in our study results. However, results of our matched analysis showed no significant difference in EOA or EOAI.…”

Early postoperative hemodynamics and clinical outcomes of patients receiving freedom solo aortic calve replacement; the Asian Experience

“…The toxic effect cannot be eliminated by rinsing the valve in similar manner such as glutaraldehyde-fixed bioprostheses. (16) All these researches were not associated with thromboembolic or hemorrhagic complications. However, a research done by Beholz S. and associates which published in 2010 revealed none of the patients reported to have severe thrombocytopenia as a compli-cation.…”

“…Mean echocardiographic data collected in short and mid-term by different studies show a low number of paravalvular leakage and aortic regurgitation. (7,16,17) However, early complications did occur in 2 patients. One patient had left hand ischaemia and low cardiac output syndrome 20 days after the operation and the other one had hemorrhage from the sternal wire puncture site a day after valve replacement.…”

“…Many research found that the use of this valve was associated with postoperative thrombocytopenia. (13,14,15,16) However, research conducted by Beholz et al found none of the study reported severe thrombocytopenia as an adverse event. (17) Hence, in spite of increase in the usage of FS valve, there is still controversy regarding its complication.…”

Evaluation of Thrombocytopaenia-Related Complications After Bioprosthetic Aortic Valve Implantation

“…However, long-term survival has not been shown to be significantly different in randomised studies (6,7) . Sorin Freedom Solo and Sorin Pericarbon Freedom are the latest generation of stentless aortic tissue valves, which have structural flexibility, an easy single-suture implantation technique and excellent haemodynamics (8,9) . However, postoperative thrombocytopaenia (TCP) is a potentially serious problem following implantation, and recent reports have suggested a strong relationship (10)(11)(12)(13)(14)(15)(16)(17)(18) .…”