Vogt Ferdinand, Moscarelli Marco, Pollari Francesco, Kalisnik Jurij M, Pfeiffer Steffen, Fittkau Matthias, Sirch Joachim, Pförringer Dominik, Jessl Jürgen, Eckner Dennis, Ademaj Fadil, Bertsch Thomas, Langhammer Christian, Fischlein Theodor, Santarpino Giuseppe
Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany.
Department of Cardiovascular Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy.
J Card Surg. 2020 Jun;35(6):1186-1194. doi: 10.1111/jocs.14547. Epub 2020 Apr 29.
Postoperative thrombocytopenia after surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) and aggravating causes were the aim of this retrospective study.
Data of all patients treated with SAVR (n = 1068) and TAVR (n = 816) due to severe aortic valve stenosis was collected at our center from 2010 to 2017. Preprocedural and postprocedural values were collected from electronic patient records.
There was a significant drop in platelets in both groups, the TAVR group showed overall superior platelet preservation compared to the AVR group (P < .001). In the SAVR subgroup analysis, a significant difference in platelet preservation was observed between the valve types (P < .001), particularly with the Freedom SOLO valve. In the TAVR subgroup analysis, the valve type did not influence platelet count (PLT) reduction (P = .13). In the SAVR subgroup analyses, PLT was found to be worsened with cardiopulmonary bypass (CPB) duration.
Thrombocytopenia frequently occurs after implantation of a biological heart valve prosthesis, with a higher frequency observed in patients after cardiac surgery rather than TAVR. Although some surgical bioprosthetic models are more susceptible to this phenomenon, CPB duration seems to be a major determinant for the development of postoperative thrombocytopenia.
本回顾性研究旨在探讨外科主动脉瓣置换术（SAVR）或经导管主动脉瓣置换术（TAVR）术后血小板减少症及其加重因素。
收集2010年至2017年在本中心因严重主动脉瓣狭窄接受SAVR（n = 1068）和TAVR（n = 816）治疗的所有患者的数据。术前和术后数据均从电子病历中收集。
两组患者血小板均显著下降，与SAVR组相比，TAVR组总体上血小板保存情况更佳（P <.001）。在SAVR亚组分析中，不同瓣膜类型之间血小板保存存在显著差异（P <.001），尤其是Freedom SOLO瓣膜。在TAVR亚组分析中，瓣膜类型不影响血小板计数（PLT）降低情况（P =.13）。在SAVR亚组分析中，发现血小板减少与体外循环（CPB）持续时间有关。
生物心脏瓣膜假体植入术后常发生血小板减少症，心脏手术后患者的发生率高于TAVR患者。虽然某些外科生物假体模型更容易出现这种现象，但CPB持续时间似乎是术后血小板减少症发生的主要决定因素。
