Résumé
Resumen: Los pacientes de mediana edad que requieren sustitución valvular aórtica quirúrgica constituyen un grupo en el que la decisión del tipo de prótesis a implantar (biológica o mecánica) continúa siendo discutida. Se realizó una búsqueda bibliográfica con el objetivo de determinar cuál de las prótesis beneficia más a este grupo. Cuando se evalúan las bioprótesis, la principal dificultad radica en el deterioro estructural, más intenso cuanto más joven es el paciente y que puede requerir reintervención por disfunción severa. Por otro lado, las prótesis mecánicas implican anticoagulación de por vida, con los riesgos derivados de este tratamiento. En el presente artículo se analiza la evidencia más significativa para orientar al médico clínico en la toma de decisiones.
Summary: Middle-aged patients who require surgical aortic valve replacement constitute a group in wich the decision of the type of prosthesis to implant (biological or mechanical) continues to be discussed. A bibliographic search was carried out in order to determine which of the prostheses benefits this group. When evaluating bioprostheses, the main difficulty lies in structural deterioration, more intense in the younger patient and that may require reintervention due to severe dysfunction. On the other hand, the mechanical prosthesis involve anticoagulation for life, with the risks derived from this treatment. The present article analyzes the most significant evidence to guide the clinical doctor in decision making process.
Résumé
Abstract Introduction: The incidence of postoperative thrombocytopenia after aortic valve replacement (AVR) with the Perceval S Sutureless bioprosthesis remains unclear. The aim of this study was to report thrombocytopenia associated with the use of sutureless AVR. Methods: The data was collected retrospectively for patients who had isolated AVR with sutureless Perceval S valve (Group A: 72 patients) and was compared with patients who underwent isolated sutured AVR with Perimount Magna Ease Bioprosthesis (Group B: 101 patients) in our institution between June 2014 and January 2017. Results: Cardiopulmonary bypass and cross-clamp time were significantly shorter in group A. Maximum drop in platelet count was 58% mean (day 2.3) in group A versus 44% mean (day 1.7) in group B (P=0.0001). Absolute platelet count on postoperative day 1-6 in group A was significantly less than in group B (P≤0.05). Platelet count recovered to preoperative value in 44% patients in group B versus only in 26% patients in group A at discharge (P=0.018). Moderate thrombocytopenia occurs more often in group A (41% vs. 26%) (P=0.008) while severe thrombocytopenia (<50 x 109) was observed in 6% in group A but never in group B. Platelets (P=0.007) and packed red blood cells (P=0.009) transfusion was significantly higher in the group A. Conclusion: The implantation of sutureless Perceval aortic valves was associated with a significant drop in platelet count postoperatively with slow recovery and higher platelets and packed red blood cells transfusion requirements. A prospective randomised trial is needed to confirm our findings.