Perioperative platelet reduction after sutureless or stented valve implantation: results from the PERSIST-AVR controlled randomized trial

Roberto Lorusso, Federica Jiritano*, Eric Roselli, Malakh Shrestha, Thierry Folliguet, Bart Meuris, Francesco Pollari, Theodor Fischlein, PERSIST-AVR Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Web of Science)



OBJECTIVES: Platelet count reduction is a common but not fully understood phenomenon after aortic valve replacement (AVR) with bioprosthesis implantation. The aim of the present study was to investigate the occurrence and the clinical impact of platelet count reduction in patients receiving the Perceval bioprosthesis compared to those receiving standard sutured stented bioprosthetic aortic valve in a randomized, controlled AVR study.

METHODS: PERceval Sutureless Implant versus STandard Aortic Valve Replacement is a prospective, randomized, adaptive, open-label trial. Patients were randomized (March 2016-September 2018) to AVR with a sutureless or stented valve. Ad hoc analyses have been performed to evaluate the occurrence of platelet count reduction and the clinical impact of the platelet variations in the 2 groups.

RESULTS: The Perceval group showed a higher platelet reduction than the control group (46% vs 32%). The phenomenon was transient in both groups, with a slow recovery of the platelet count by hospital discharge. No differences were observed between groups regarding need of transfusions, blood loss, major bleeding and stroke events.

CONCLUSIONS: The Perceval sutureless aortic bioprosthesis implantation is associated with higher rate of transient platelet reduction as compared to stented bioprostheses for AVR. However, the platelet count reduction is transient and the decline does not affect the patient's clinical outcomes. Current explanations for this phenomenon are speculative, and further investigations are required to elucidate it.


Original languageEnglish
Pages (from-to)1359-1365
Number of pages7
JournalEuropean Journal of Cardio-Thoracic Surgery
Issue number6
Publication statusPublished - 1 Dec 2021


  • Platelet
  • Biological prosthesis
  • Sutureless
  • Bleeding
  • Thrombocytopaenia

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