title: Hematologic Effects of Heart Valve Prostheses and Vascular Grafts after Aortic Root Replacement.
abstract: BACKGROUND
  Heart valve prosthesis as well as vascular grafts cause changes in blood parameters. This may correlate with valve-related complications, less frequently observed after repair surgery. We thus studied changes in rheology after Bentall, Ross, or Tirone David (TD) procedure.
  
  
  METHODS
  Seventeen patients underwent a TD, 17 patients underwent a Ross, and 16 patients underwent a Bentall procedure. Venous blood samples were collected 4 ± 3 (TD), 4 ± 3 (Ross), and 6 ± 3 years mean (Bentall) postoperatively. Concentrations of fibrinogen, leucocytes, platelets, haptoglobin, hemoglobin, lactate dehydrogenase (LDH), bilirubin, hematocrit, and β-thromboglobulin were determined. Platelet function and activity were analyzed. Results were compared with those of healthy control subjects.
  
  
  RESULTS
  Level of fibrinogen was higher in the Bentall than in the other two groups (338 ± 63 vs. 298 ± 43 Ross and 308 ± 48 mg/dL TD, p > 0.05). LDH was also elevated in the Bentall group (311 ± 45 vs. 205 ± 30 Ross, p < 0.01 and 203 ± 34 U/l TD, p < 0.01). Platelet count and haptoglobin levels were significantly reduced in the Bentall (190 ± 43/nL, 2.4 ± 1 mg/dL) and TD groups (183 ± 52/nL, 89 ± 57 mg/dL) in comparison to the control group (250 ± 86/nL, 140 ± 53 mg/dL) with p < 0.05, whereas there were no significant differences in the Ross group (214 ± 47/nL and 129 ± 54 mg/dL) in comparison to the control group. Leucocyte count and platelet function showed no significant differences between the groups.
  
  
  CONCLUSIONS
  Polyester ascending aortic prostheses and more pronounced when combined with a prosthetic aortic valve cause hematologic changes compared with minimal deviations in Ross patients. We observed mild hemolysis, a decreased platelet count, and an increase in fibrinogen level in patients after conduit root replacement compared with procedures retaining an autologous aortic valve at midterm follow-up.
authors.affiliation: Department of Thoracic, and Cardiovascular Surgery, Goethe University Hospital, Frankfurt a.M., Germany.
authors.forename: Nadejda
authors.initials: N
authors.lastname: Monsefi
authors.affiliation: Department of Thoracic, and Cardiovascular Surgery, Goethe University Hospital, Frankfurt a.M., Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Zierer
authors.affiliation: Department of Thoracic, and Cardiovascular Surgery, Goethe University Hospital, Frankfurt a.M., Germany.
authors.forename: Andres
authors.initials: A
authors.lastname: Beiras-Fernandez
authors.affiliation: Department of Thoracic, and Cardiovascular Surgery, Goethe University Hospital, Frankfurt a.M., Germany.
authors.forename: Isabella
authors.initials: I
authors.lastname: Werner
authors.affiliation: Department of Anesthesiology, Goethe University Hospital, Frankfurt a.M., Germany.
authors.forename: Christian Friedrich
authors.initials: CF
authors.lastname: Weber
authors.affiliation: Department of Angiology and Hemosthaseology, Goethe University Hospital, Frankfurt a.M., Germany.
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Wolf
authors.affiliation: Department of Thoracic, and Cardiovascular Surgery, Goethe University Hospital, Frankfurt a.M., Germany.
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
mesh_terms: D001013:Aorta, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006487:Hemostasis / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D013997:Time Factors; D014463:Ultrasonography