Department of Cardiac Surgery, Medical University, Bialystok, Poland.
Kardiol Pol. 2013;71(4):334-40. doi: 10.5603/KP.2013.0060.
Freedom Solo (FS) stentless bioprostheses have superior haemodynamic performance compared to stented valves; however, the data of thrombocytopenia after FS implantations is disturbing.
To compare platelet count and perioperative complications between stentless and stented biological valves in patients undergoing aortic valve replacement.
In 29 patients, FS bovine valves (Sorin Group, Saluggia, Italy) were implanted. Platelet counts were analysed before surgery, on the day of operation, on four consecutive postoperative days (POD) as well as at discharge, and compared to 29 control patients with biological stented porcine valves (Labcor Laboratorios TLBP-A Supra). The analysis of the perioperative variables extracorporeal circulation (ECC), aortic cross clamping (XC) and mechanical ventilation times, as well as blood supply, was performed.
Initial platelet counts were comparable in both groups. In the FS group, platelet levels on the four consecutive POD were significantly lower. The lowest platelet value (13 × 10³/μL), related to fatal thrombotic thrombocytopenic purpura, was found in one patient from the FS group. ECC as well as XC and mechanical ventilation times, were significantly longer in the FS group, and more blood transfusions in these patients were required. In multiple regression analysis, ECC and XC times did not correlate with platelet count.
Implantations of FS stentless bioprostheses are related to significantly lower platelet counts. Severe perioperative complications and their relation to thrombocytopenia need further evaluation.
Freedom Solo（FS）无支架生物瓣与带支架瓣膜相比具有更好的血液动力学性能；然而，FS 植入后血小板减少的数据令人不安。
比较无支架和带支架生物瓣膜在主动脉瓣置换患者中的血小板计数和围手术期并发症。
在 29 例患者中植入 FS 牛瓣（Sorin Group，Saluggia，意大利）。分析术前、手术当天、连续 4 天术后（POD）以及出院时的血小板计数，并与 29 例带支架猪生物瓣（Labcor Laboratorios TLBP-A Supra）的对照组患者进行比较。分析体外循环（ECC）、主动脉阻断（XC）和机械通气时间以及血液供应等围手术期变量。
两组初始血小板计数相当。在 FS 组，连续 4 天 POD 的血小板水平明显较低。在 FS 组的一名患者中发现了最低的血小板值（13×10³/μL），与致命性血栓性血小板减少性紫癜有关。FS 组的 ECC 以及 XC 和机械通气时间明显延长，这些患者需要更多的输血。在多元回归分析中，ECC 和 XC 时间与血小板计数无关。
FS 无支架生物瓣的植入与血小板计数明显降低有关。严重的围手术期并发症及其与血小板减少的关系需要进一步评估。
