Peri-procedural thrombocytopenia after aortic bioprosthesis implant: A systematic review and meta-analysis comparison among conventional, stentless, rapid-deployment, and transcatheter valves. (1st December 2019)

• Record Type: Journal Article
• Authors: Jiritano, Federica; Santarpino, Giuseppe; Serraino, Giuseppe Filiberto; Ten Cate, Hugo; Matteucci, Matteo; Fina, Dario; Mastroroberto, Pasquale; Lorusso, Roberto
• Is Part Of: International journal of cardiology. Volume 296(2019)
• Page Start: 43
• Page End: 50
• Publication Date: 2019-12-01
• Subjects: Platelet -- Thrombocytopenia -- Aortic valve replacement -- Trans-catheter aortic valve implantation -- Bleeding; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2019.07.056
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Thrombocytopenia has been shown to occur soon after surgical biological aortic valve replacement (AVR), and recently reported also after transcatheter valve implantation (TAVI). The mechanism underlying this phenomenon is still unknown, and its clinical impact on the peri-operative outcome has been poorly investigated. Methods: A systematic review and a meta-analysis of all available studies reporting data about peri-procedural thrombocytopenia on isolated bio-AVR, comparing rapid-deployment (RDV), stentless (stentless-AVR), and TAVI vs. stented (stented-AVR) valves, have been performed. Results: Fifteen trials (2.163 patients) were included in the meta-analysis. Perioperative platelet reduction ranged from 35% to 55% in stented-AVR, from 60% to 77% in stentless-AVR, from 53% to 60% in RDV, and from to 21% to 72% in TAVI (apparently, balloon-expandable valves more frequently associated to thrombocytopenia). Stented-AVR required more red blood cells transfusion than stentless-AVR ( P < 0.0001), whereas no difference has been found between RDV and stented-AVR. Platelet transfusion rate was very low in all surgical groups. No difference has been found in RDV and stentless-AVR vs. stented-AVR, in terms of reoperation for bleeding, and length-of-intensive care unit or hospital stay. Conclusions: Thrombocytopenia-related major adverse events were mainly reported in TAVI patients, whereas clinically meaningless in surgical patients. Transient peri-procedural thrombocytopenia is common after bio-AVR, regardless of prosthesis's type or implant modality. It should receive appropriate monitoring and focused investigations. Highlights: Thrombocytopenia has been reported after surgical biological aortic valve replacement. Perioperative thrombocytopenia is often a transient event. Thrombocytopenia may occur also in trans-catheter aortic valve implantation patients. Patients receiving balloon-expandable valves seem more prone to develop thrombocytopenia. Thrombocytopenia is not a subclinical event, but it could impact patients' postoperative course.