Thrombocytopenia in Moderate- to High-Risk Sutureless Aortic Valve Replacement

BACKGROUND: This study aimed to compare preliminary data on the outcomes of sutureless aortic valve replacement (SU-AVR) with those of aortic valve replacement (AVR). METHODS: We conducted a retrospective study of SU-AVR in moderate- to high-risk patients from 2013 to 2016. Matching was performed at a 1:1 ratio using the Society of Thoracic Surgeons predicted risk of mortality score with sex and age. The primary outcome was 30-day mortality. The secondary outcomes were operative outcomes and complications. RESULTS: A total of 277 patients were studied. Ten patients (50% males; median age, 81.5 years) underwent SU-AVR. Postoperative echocardiography showed impressive outcomes in the SU-AVR group. The 30-day mortality was 10% in both groups. In our study, the patients in the SU-AVR group developed postoperative thrombocytopenia. Platelet counts decreased from 225×10³/μL preoperatively to 94.5, 54.5, and 50.1×10³/μL on postoperative days 1, 2, and 3, respectively, showing significant differences compared with the AVR group (p=0.04, p=0.16, and p=0.20, respectively). The median amount of platelet transfusion was higher in the AVR group (12.5 vs. 0 units, p=0.052). CONCLUSION: There was no difference in the 30-day mortality of moderate- to high-risk patients depending on whether they underwent SU-AVR or AVR. Although SU-AVR is associated with favorable cardiopulmonary bypass and cross-clamp times, it may be associated with postoperative thrombocytopenia.

The Norwood procedure for hypoplastic left heart syndrome: results of the King Chulalongkorn Memorial Hospital

Background: The Norwood procedure is often performed to treat hypoplastic left heart syndrome (HLHS). Only Blalock-Taussig (BT) shunt is used with the Norwood procedure in our institute.Objective: To analyze the first-stage palliation for HLHS.Patients and methods: The Norwood procedure with right modified BT shunt was performed in 26 patients with HLHS between August 1996 and November 2008. The first four patients were performed using only autologous great vessel tissue (group 1), and the other 22 patients were operated with the Norwood procedure using a homograft for arch reconstruction (group 2).Results: The hospital mortality was 50.0 % in group 1 and 18.2% in group 2. The overall hospital mortality was 23.1%. Four out of twenty survivors (20%) had the modified Fontan procedure.Conclusion: Only a limited number of pediatric cardiac centers offered surgical treatment of the hypoplastic left heart syndrome. The survival rate in our study was in acceptable range despite the limited resource.