TY - JOUR
T1 - Peri-procedural thrombocytopenia after aortic bioprosthesis implant
T2 - A systematic review and meta-analysis comparison among conventional, stentless, rapid-deployment, and transcatheter valves
AU - Jiritano, Federica
AU - Santarpino, Giuseppe
AU - Serraino, Giuseppe Filiberto
AU - Ten Cate, Hugo
AU - Matteucci, Matteo
AU - Fina, Dario
AU - Mastroroberto, Pasquale
AU - Lorusso, Roberto
N1 - Publisher Copyright:
© 2019 The Authors
PY - 2019/12/1
Y1 - 2019/12/1
N2 - 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 periprocedural 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. (C) 2019 The Authors. Published by Elsevier B.V.
AB - 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 periprocedural 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. (C) 2019 The Authors. Published by Elsevier B.V.
KW - Platelet
KW - Thrombocytopenia
KW - Aortic valve replacement
KW - Trans-catheter aortic valve implantation
KW - Bleeding
KW - PLATELET COUNT
KW - CARDIAC-SURGERY
KW - REPLACEMENT
KW - SUTURELESS
KW - ASSOCIATION
KW - HEPARIN
KW - TAVI
KW - MORTALITY
U2 - 10.1016/j.ijcard.2019.07.056
DO - 10.1016/j.ijcard.2019.07.056
M3 - (Systematic) Review article
C2 - 31351790
SN - 0167-5273
VL - 296
SP - 43
EP - 50
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -