Repossini Alberto, Bloch Daniel, Muneretto Claudio, Piccoli Paolo, Bisleri Gianluigi, Beholz Sven
Department of Cardiac Surgery, University of Brescia, Brescia, Italy.
Interact Cardiovasc Thorac Surg. 2012 Apr;14(4):434-8. doi: 10.1093/icvts/ivr069. Epub 2012 Jan 24.
The aim of the study was to investigate the multi-factorial phenomenon of possible postoperative thrombocytopenia after aortic valve replacement (AVR) with the freedom SOLO (FS) bioprosthesis. A total of 254 patients underwent AVR with FS bioprosthesis in two cardiac surgery institutes. Platelet counts were measured preoperatively, immediately postoperatively and daily until the 11th day postoperatively. A multivariate generalized estimating equation model was applied to identify prognostic factors for whether or not patients postoperative platelet counts indicated no thrombocytopenia (platelet count >150 10(3)/mm(3)) versus at least mild thrombocytopenia (≤150 10(3)/mm(3)). Preoperatively, 11.2% of patients showed thrombocytopenia. The preoperative platelet count averaged 233.0 ± 83.2 10(3)/mm(3). The postoperative mean of platelet counts decreased daily reaching a minimum mean of 88.4 ± 58.8 10(3)/mm(3) 3 days after surgery and then started to increase, with the Day 11 postoperative mean of 173.3 ± 51.8 10(3)/mm(3). Compared with patients with no preoperative thrombocytopenia, patients with preoperative thrombocytopenia had an 8.69 increased odds of being in the group with postoperative platelet count <150 10(3)/mm(3). No major haemorrhagic or thromboembolic event was reported during hospitalization. This study shows that thrombocytopenia after the FS bioprosthesis replacement is a transient postoperative phenomenon, largely resolved within a few days after surgery, with no clinical consequences and haemodynamic dysfunction.
本研究的目的是探讨使用Freedom SOLO(FS)生物瓣膜进行主动脉瓣置换术(AVR)后可能出现的术后血小板减少这一多因素现象。在两家心脏外科机构中,共有254例患者接受了FS生物瓣膜的AVR手术。术前、术后即刻以及术后每日直至第11天均测量血小板计数。应用多变量广义估计方程模型来确定患者术后血小板计数是否表明无血小板减少(血小板计数>150×10³/mm³)与至少轻度血小板减少(≤150×10³/mm³)的预后因素。术前,11.2%的患者出现血小板减少。术前血小板计数平均为233.0±83.2×10³/mm³。术后血小板计数平均值每日下降,在术后3天达到最低平均值88.4±58.8×10³/mm³,然后开始上升,术后第11天的平均值为173.3±51.8×10³/mm³。与术前无血小板减少的患者相比,术前有血小板减少的患者术后血小板计数<150×10³/mm³的组中,其比值比增加了8.69。住院期间未报告重大出血或血栓栓塞事件。本研究表明,FS生物瓣膜置换术后的血小板减少是一种术后短暂现象,在术后几天内基本缓解,无临床后果和血流动力学功能障碍。