Thrombocytopenia After Sutureless and Rapid Deployment Aortic Valve Replacement in Contrast to Conventional Aortic Valve Replacement

Background: Sutureless (S-SAVR) and rapid deployment (R-SAVR) aortic valve replacement has become an alternative to conventional surgical biological aortic valve replacement (C- SAVR). Following S-SAVR and R-SAVR, a higher incidence of thrombocytopenia was observed. Aim of this study was to further investigate clinical postoperative impact of thrombocytopenia.

Methods: In a retrospective single-center study n = 381 patients underwent either a S-SAVR (n = 249) or R-SAVR (n = 132) within the past 10 years. As primary endpoints thrombocyte count, bleeding tendency and freedom from re-intervention were defined. Thrombocyte count and development during the stay was monitored from day of admission until discharge. Bleeding tendency was defined according to the Valve Academic Research Consortium (VARC-3) criteria. 30-day mortality and total days of in-hospital stay were defined as secondary endpoints. Subsequently the results were compared to patients that have received C-SAVR in the same clinic.

Results: The preoperative risk assessment including EuroSCORE II, demographic data and medical history showed no significant differences between groups. Cardiopulmonary bypass time (97 ± 49 min vs. 67 ± 18 min) and cross-clamp time (60 ± 25 min vs. 42 ± 10 min) was significantly longer in the S-SAVR group. In both groups a medium sized prosthesis (23 mm/M) dominated (37% vs. 33%). Both collectives showed a postoperative thrombocyte count drop (<150.000/µL). On the third and fourth postoperative day, a significant difference in platelet count between both groups (S-SAVR: 131 ± 52 vs. 110 ± 59, R-SAVR: 138 ± 61 vs. 113 ± 62) was observed, as well as at discharge (314 ± 126 vs. 196  ± 113). No difference in bleeding tendency and blood transfusion was observed. Freedom from re-intervention was significantly higher in the S-SAVR group (2% vs. 10%). The 30-day mortality rate did not differ between the groups (3% vs. 6%). The control group of C-SAVR had no thrombocytopenia at discharge.

Conclusion: The study revealed a significant drop in thrombocyte count after S-SAVR and R-SAVR in contrast to C-SAVR, with more severity in the R-SAVR group. Bleeding tendency and 30-day mortality did not show significant differences and thrombocytopenia was not associated with re-intervention for bleeding. Nevertheless, a temporary thrombocytopenia should be kept in mind, especially for patients with coagulopathy.

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Artikel online veröffentlicht:
13. Februar 2024