Platelet Count Drop After Aortic Valve Bioprostheses Implantation: Short and Long-Term Outcomes.

Abstract

Background: Surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) have evolved significantly in recent years. Postoperative thrombocytopenia has been observed after both techniques. The study aimed to assess if postprocedural platelet count drop (PCD) influenced early results and 1-year survival in patients treated with SAVR and TAVI. The secondary aim was to compare the degrees of PCD between techniques.

Method: The retrospective single-centre study involved patients treated for symptomatic aortic stenosis. Periprocedural platelet count characteristic was evaluated. One-year mortality was assessed.

Results: The study group consisted of 313 patients, including the Perceval group (n=73), the Resilia group (n=17), the TAVI group treated between 2013 and 2017 (n=140), and with newer bioprostheses implanted between May 2021 and July 2022 (n=83). Baseline platelet count did not differ between groups (p=0.116). All patients, apart from two (both in the TAVI groups), presented with any postprocedural PCD. The most prominent PCD in all groups was observed on the second and third postoperative days but was the most pronounced in the Perceval prosthesis group (p<0.001), with PCD >50% in 66 patients (90.4%). Twenty-two (22) patients died during the first postoperative year, five in the new TAVI, 12 in the early TAVI, and five in the Perceval groups. Patients who died did not differ significantly in PCD value compared with 1-year survivors in all study groups. A probability of 1-year survival according to the Kaplan-Meier curve was comparable between the studied groups (p=0.793). Early TAVI patients with PCD >50% were burdened with a higher risk of complications, including bleeding complications (p=0.032), blood transfusion (p=0.04), and acute kidney injury (p=0.005).

Conclusions: Thrombocytopenia is a common phenomenon in patients treated with TAVI and SAVR but has no impact on 1-year survival. The implantation of newer models of bioprostheses, both transcatheter and surgical, is associated with a smaller decrease in platelet counts.