Department of Cardiothoracic Surgery, Fondazione G. Monasterio CNR-Regione Toscana, Via Aurelia Sud, 54100 Massa, Italy.
Eur J Cardiothorac Surg. 2012 Jan;41(1):69-73. doi: 10.1016/j.ejcts.2011.04.015.
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.
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.
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.
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.
关于接受主动脉瓣置换术（AVR）的患者发生血小板减少症的风险，使用 Freedom Solo（FS）生物瓣存在争议。本研究旨在评估接受 FS 生物瓣行单纯生物瓣 AVR 的患者术后血小板计数和功能的变化。
2005 年 5 月至 2010 年 6 月，共有 322 例患者接受了单纯生物瓣 AVR。其中，116 例患者接受了 FS，与 206 例接受生物瓣的患者进行比较。分别在基线（T0）、第 1 天（T1）、第 2 天（T2）和第 5 天（T3）检测血小板计数、平均血小板体积（MPV）和血小板分布宽度（PDW）。
总体住院死亡率为 1.5%，两组间无差异。37 例（11.5%）患者发生血小板减少症。与对照组相比，FS 植入组血小板减少症的发生率更高（24.1%比 4.4%，p<0.0001）。FS 组在 T1（99.4±38×10³ μl（-1）比 122.5±41.6×10³ μl（-1），p<0.001）、T2（79.7±36.3×10³ μl（-1）比 122.5±43.3×10³ μl（-1），p<0.001）和 T3（86.6±57.4×10³ μl（-1）比 158.4±55.8×10³ μl（-1），p<0.001）时的血小板计数均低于对照组。此外，FS 组在 T3 时的 MPV（11.6±0.9 fl 比 11±1 fl，p<0.001）和 PDW（15.1±2.3 fl 比 13.9±2.1 fl，p<0.001）也更高。多变量分析显示，FS（p<0.0001）、体表面积（p<0.0001）、体外循环时间（p=0.003）和较低的术前血小板计数（p=0.006）是血小板减少症的独立预测因素。
FS 瓣膜可能会增加血小板减少症和血小板活化的风险，但无不良临床事件发生。需要前瞻性随机研究来证实我们的数据。
