Initial Thrombocyte Concentrate Transfusion in Woman with Chronic Immune Thrombocytopenia Purpura (ITP) Who Underwent Mitral Valve Replacement Surgery: A Case Report.

BACKGROUND Chronic immune thrombocytopenia purpura (ITP) is associated with a higher incidence of adverse outcomes, increased morbidity and mortality rates, and higher health care costs, especially in open-heart surgery. The information regarding managing chronic ITP in patients undergoing mitral valve replacement (MVR) surgery is scarce, and reported cases are limited. CASE REPORT A 42-year-old woman with more than 20 years of history of immune thrombocytopenia purpura (ITP) had episodes of breathing difficulties in the last 4 years. The patient was diagnosed with severe mitral stenosis (MS) and moderate mitral regurgitation (MR). Laboratory examination before surgery showed thrombocytopenia (49 000/µL). Therefore, the surgery was postponed until the platelet count exceeded 100 000/µL. The patient was given 10 units of thrombocyte concentrate 1 day before surgery and 500 mg of methylprednisolone 3 times a day orally for 5 days as preoperative management. Under a total cardiopulmonary bypass, MVR was performed using a bioprosthetic valve. Postoperative transthoracic echocardiography (TTE) showed no valvular leakage in the surrounding of the prosthetic valve and that the valve was functioning normally. Platelet monitoring was conducted, and the platelet count increased to 147 000/µL on the third day. CONCLUSIONS Our case report shows that aggressive preoperative platelet count correction and treatment may lower the risk associated with a low and unstable platelet count and reduce the risk of mortality and morbidity in patients with ITP who undergo MVR procedures.

Comparison of risk stratification scoring system as a predictor of mortality and morbidity in congenital heart disease patients requiring surgery.

Backgrounds: Risk stratification systems have been important in reducing morbidity and mortality among congenital heart disease (CHD) patients requiring cardiac surgery. Multiple risk stratification scoring systems have been developed, including Aristotle Basic Complexity Score (ABC), Aristotle Comprehensive Complexity Score (ACC), Society of Thoracic Surgeons and European Association for Cardiothoracic Surgery (STS-EACTS), and Risk Adjustment in Congenital Heart Surgery (RACHS-1). This study aims to access the superior risk stratification scoring system model in predicting mortality and morbidity. Methods: The authors used Embase, PubMed, Scopus, and ProQuest as the primary databases for searching and included studies from hand searching. The area under the receiver operating characteristic curve was compared. Results: A total of 11 articles were included in this review. The AUC of ABC for predicting mortality ranges from 0.59 to 0.71, and morbidity ranges from 0.673 to 0.743. The AUC of ACC score for predicting mortality ranges from 0.704 to 0.87, and a study revealed the AUC of morbidity is 0.730. The AUC of RACHS-1 for predicting mortality ranges from 0.68 to 0.782. The AUC of STS-EACTS for predicting mortality ranges from 0.739 to 0.8 and 0.732 for predicting morbidity. Conclusion: ABC, ACC, RACHS-1, and STS-EACTS have acceptable to excellent discriminatory ability in predicting mortality and morbidity among CHD patients requiring cardiac surgery.