title: Thrombocytopenia after Aortic Valve Replacement with Perceval S Sutureless Bioprosthesis.
abstract: BACKGROUND AND AIM OF THE STUDY: Sutureless aortic bioprosthetic valves have become an alternative to conventional bioprostheses in high surgical risk cases. A significant decline in platelet count during the immediate postoperative period was observed in cases of Perceval S sutureless aortic valve implantation. The study aim was to determine how the reduction in platelet count after Perceval S prosthesis implantation compared to that after other bioprosthesis implants.
  
  METHODS: Between July 2011 and July 2014, a total of 77 isolated biological aortic valve replacements (AVRs) was performed at the authors’ institution. These included 27 Perceval S prostheses (35.1%) and 50 Mitroflow prostheses (64.9%). Platelet counts and mean platelet volumes (MPVs) were determined on the day before surgery (T0) and at 24 h (T1), 48 h (T2) and 72 h (T3) after surgery.
  
  RESULTS: There were no significant differences in inhospital mortality (three Perceval S (11.1%) versus four Mitroflow 8%); p = 0.65), nor in morbidity between groups. A total of 16 patients (20.8%) had severe postoperative thrombocytopenia (<50×103/mm3). The incidence of severe thrombocytopenia was significantly higher (p = 0.046) in Perceval S patients (n = 9; 33.3%) than in Mitroflow patients (n = 7; 14%). The platelet count recovered in all patients with severe thrombocytopenia. In an adjusted-propensity multivariate logistic regression analysis, the Perceval S prosthesis was the major independent predictor of severe thrombocytopenia after AVR (OR 0.06, 95% CI: 0008-0.5, p = 0.009).
  
  CONCLUSION: Aortic bioprosthesis implantation with the Perceval S sutureless bioprosthesis appears to be associated with the occurrence of postoperative thrombocytopenia, though without any clinical implication for the patients. Prospective randomized trials are required to confirm these data.
authors.affiliation: Department of Cardiovascular Surgery, Hospital Infanta Cristina, Badajoz, Spain.
authors.forename: Eladio
authors.initials: E
authors.lastname: Sánchez
authors.affiliation: Department of Cardiovascular Surgery, Hospital Infanta Cristina, Badajoz, Spain.
authors.forename: Jose-Antonio
authors.initials: JA
authors.lastname: Corrales
authors.affiliation: Department of Cardiovascular Surgery, Hospital Infanta Cristina, Badajoz, Spain.
authors.forename: Pasnayotis
authors.initials: P
authors.lastname: Fantidis
authors.affiliation: Department of Cardiovascular Surgery, Hospital Infanta Cristina, Badajoz, Spain.
authors.forename: Ibrahim S
authors.initials: IS
authors.lastname: Tarhini
authors.affiliation: Department of Cardiovascular Surgery, Hospital Infanta Cristina, Badajoz, Spain.
authors.forename: Ijaz
authors.initials: I
authors.lastname: Khan
authors.affiliation: Department of Cardiovascular Surgery, Hospital Infanta Cristina, Badajoz, Spain.
authors.forename: Tomás
authors.initials: T
authors.lastname: Pineda
authors.affiliation: Department of Cardiovascular Surgery, Hospital Infanta Cristina, Badajoz, Spain.
authors.forename: Jose-Ramon
authors.initials: JR
authors.lastname: González
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001705:Bioprosthesis / Q000009:adverse effects*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011474:Prosthesis Design; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D000071062:Sutureless Surgical Procedures / Q000401:mortality; D013921:Thrombocytopenia / Q000209:etiology*