Thrombocytopenia Associated with Perceval Sutureless Aortic Valve Replacement in Elderly Patients: A Word of Caution

Abstract

Objective: The aim of this study was to report for the first time the phenomenon of thrombocytopenia associated with the use of sutureless aortic valve replacements (AVR), and try to find an explanation for its occurrence.

Methods: The data was collected retrospectively for all patients who had sutureless AVR (7 patients) and was compared to patients who underwent sutured AVR (22 patients) by the same surgeon between February 2012 and November 2013. 

Results: Cardiopulmonary bypass and cross-clamp durations were shorter in the sutureless group (96.4 min,
70.6 min) compared to the sutured group (128.3 min, 97.3 min),
(P = .04, P = .003) respectively. Mean transvalvular gradients were lower in the sutureless group (mean = 9.6 mmHg) compared to the sutured group (mean = 17.3 mmHg). Platelet levels were significantly lower in the Perceval patients compared to the Enable patients and sutured valves. Platelet transfusion was higher for sutureless valves (6.5 units versus 5.4 units for the sutured group, P = .63), especially the Perceval valve (7.6 units versus 5.3 for the Enable valve, P = .35), but was not statistically significant. Packed red blood cells (PRBCs) transfusion was significantly higher in the sutureless group (6 units versus 3.1 for the sutured group, P = .002). 

Conclusion: The implantation of sutureless aortic valves, especially the Perceval valve, was associated with a significant drop in platelet count postoperatively with slow recovery and higher PRBCs transfusion requirements. Extreme caution should be taken before the routine use of these valves in elderly patients who are already at risk of thrombocytopenia postoperatively.