Interact CardioVasc Thorac Surg 2009;8:73-74. doi:10.1510/icvts.2008.188524B
© 2009 European Association of Cardio-Thoracic Surgery
eComment: Freedom Solo stentless aortic bioprosthesis and postoperative thrombocytopenia – interpretation of available data and clinical consequences for surgeons
Can Yerebakan,
Bernd Westphal,
Gustav Steinhoff and
Andreas Liebold
Department of Cardiac Surgery, University of Rostock, Schillingallee 35, 18057 Rostock, Germany
Differences in the recovery of platelet counts after biological aortic valve replacement
We read the paper by Hilker and colleagues on their analysis of postoperative platelet counts after aortic valve replacement with two different types of pericardial bioprostheses with great interest [1]. The authors were able to confirm our data by showing a significant reduction and a slower recovery of platelet counts during the first postoperative week after implantation of the Freedom Solo stentless bioprosthesis within a larger cohort of patients [2].
The origin of this phenomenon is still unknown and it has been observed in many centers around Europe without consequent publication until the year 2008. We do think there are some points that should be emphasized.
In our series, we observed a reduction in the platelet count down to 20% of the initial value in eight of the patients in the Freedom Solo group (n=20), whereby five of these patients had platelet count drops to levels under 30,000/µl. Did the authors observe any patient within their group with similarly severe thrombocytopenia? Did any patient receive platelet concentrates and were there differences in blood product delivery between the groups? As our patients were subjected to a more severe decrease, it would be helpful to know which postoperative medications your patients received. Especially with respect to cases of coronary artery bypass surgery, did you administer a loading dose of aspirin in the early postoperative period, in some patients clopidogrel as an alternative to aspirin or dual platelet inhibition? In how many patients did you perform a heparin-induced thrombocytopenia (HIT) investigation and did you change your anticoagulation regime by switching to alternative agents for anticoagulation in cases when HIT was suspected? Did you perform platelet counts in all patients every day during the first five days? Why are there no values presented past the fifth postoperative day?
We think that in order to achieve a sound interpretation of the limited available data, detailed inter-institutional comparison of information is inevitable. Taken together, our results and those of Hilker et al. as well as several personal communications from users of the Freedom Solo valve there is an unpredictable risk of severe thrombocytopenia in the postoperative course. The valve should therefore only very cautiously be implanted in patients who would need a dual platelet inhibition. To ensure ultimate safety for our patients the underlying mechanism and the clinical consequences of this phenomenon should further be investigated.
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References
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- Hilker L, Wodny M, Ginesta M, Wollert HG, Eckel L. Differences in the recovery of platelet counts after biological aortic valve replacement. Interact CardioVasc Thorac Surg 2009;8:70–74.[Abstract/Free Full Text]
- Yerebakan C, Kaminski A, Westphal B, Kundt G, Ugurlucan M, Steinhoff G, Liebold A. Thrombocytopenia after aortic valve replacement with the Freedom Solo stentless bioprosthesis. Interact CardioVasc Thorac Surg 2008;7:616–620.[Abstract/Free Full Text]
Related Article
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Differences in the recovery of platelet counts after biological aortic valve replacement
- Lutz Hilker, Michael Wodny, Mario Ginesta, Hans-Georg Wollert, and Lothar Eckel
Interactive CardioVascular and Thoracic Surgery 2009 8: 70-73.
[Abstract]
[Full Text]
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