Thrombocytopenia After Aortic Valve Replacement: Comparison Between Sutureless Perceval S Valve and Perimount Magna Ease Bioprosthesis

Abstract

IntroductionThe 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.MethodsThe 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.ResultsCardiopulmonary 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.ConclusionThe 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.

An overlooked fact: thrombocytopenia following bioprosthetic aortic valve replacement

“…In their study using Perceval sutureless aortic valves, Mujtaba et al . found a significant decrease in platelet count, requiring platelet suspension and erythrocyte transfusion [17].…”

Reply from authors: thrombocytopenia after implantation of a perceval s aortic bioprosthesis should be studied more vigorously, not less

“…Meanwhile, several studies had documented postoperative thrombocytopenia after Perceval S implantation. [3][4][5][6][7][8] These studies, like our own, suggest that the thrombocytopenia after implantation of the Perceval S aortic bioprosthesis is more pronounced than the thrombocytopenia that is commonly found after aortic valve implantation with other bioprostheses. We therefore believe that these conditions should not be mixed, as Vendramin and Bortolotti 1 seem to do.…”

Positive Heparin/PF4 Antibodies and High Mortality Rate: a Retrospective Case-Series Analysis

“…Patients undergoing CPB surgery receive large volumes of heparin infusion during this procedure, and their blood platelet counts can fall 30-50% within the first 72 hours of the postoperative period [ 9 ] . Thrombocytopenia was also reported to occur following transcatheter valve-in-valve ımplantation and aortic valve replacement [ 10 , 11 ] . Besides drug-induced thrombocytopenia, an extended platelet contact with artificial surfaces as a part of extracorporeal circulation is one of the major factors leading to low platelet counts [ 12 , 13 ] .…”