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Backgropund and Aim: Postoperative thrombocytopenia after surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) and aggravating causes were the aim of this retrospective study., Methods: Data of all patients treated with SAVR (n = 1068) and TAVR (n = 816) due to severe aortic valve stenosis was collected at our center from 2010 to 2017. Preprocedural and postprocedural values were collected from electronic patient records., Results: There was a significant drop in platelets in both groups, the TAVR group showed overall superior platelet preservation compared to the AVR group (P < .001). In the SAVR subgroup analysis, a significant difference in platelet preservation was observed between the valve types (P < .001), particularly with the Freedom SOLO valve. In the TAVR subgroup analysis, the valve type did not influence platelet count (PLT) reduction (P = .13). In the SAVR subgroup analyses, PLT was found to be worsened with cardiopulmonary bypass (CPB) duration., Conclusion: Thrombocytopenia frequently occurs after implantation of a biological heart valve prosthesis, with a higher frequency observed in patients after cardiac surgery rather than TAVR. Although some surgical bioprosthetic models are more susceptible to this phenomenon, CPB duration seems to be a major determinant for the development of postoperative thrombocytopenia., (© 2020 Wiley Periodicals, Inc.)

Background: Sutureless aortic valve prostheses have the potential of shortening surgical time, but if this results in improved clinical outcome remains to be determined. The aim of this study was to compare the outcome of patients undergoing conventional vs. minimally invasive AVR, with either a stented or sutureless bioprosthesis., Methods: From 2007 to 2015, 627 patients underwent elective isolated AVR and were divided into three groups: patients who underwent sutureless-AVR via J sternotomy (group A, N.=206) and patients who underwent stented-AVR via J sternotomy (group B, N.=247) or full-sternotomy (group C, N.=174)., Results: Patients in group A were significantly older than groups B and C (77±5 vs. 74±7 and 70±8 years; P<0.001). Aortic cross-clamp and cardiopulmonary bypass times were shorter in group A than in groups B and C. As expected, aortic cross-clamp time was prolonged in group B as compared to groups A and C (60±18 vs. 36±10 and 54±16 min; P<0.001). After multivariate adjustment, minimally invasive AVR resulted in significantly fewer postoperative complications in terms of drainage bleeding and the need for blood transfusions (385±287 vs. 500±338 mL, P=0.006; and 1.3±2.1 vs. 1.8±2.6 IU, P=0.001, respectively). No differences in postoperative outcomes were observed among groups., Conclusions: The minimally invasive approach confers a protective effect against bleeding complications, but it is time-consuming. The use of sutureless valves is associated with significantly shorter surgical times compared with stented bioprostheses. In addition, no differences in mortality were observed among groups, and patients who received a sutureless valve, though significantly older, showed a better clinical outcome than patients who received a stented valve.

Sutureless aortic bioprostheses have been developed for use in high-risk patients undergoing surgical aortic valve replacement due to severe aortic stenosis. These devices are mounted on a stent and are self-anchoring within the aortic annulus with no need for sutures, resulting in shorter operative and, hence, ischemic times. The use of these devices makes therefore valve implantation easier and faster, which seems to improve postoperative outcomes. At present, there are two commercially available sutureless aortic valves: the Perceval S (LivaNova Group, Milan, Italy) and the Intuity (Edwards Lifesciences, Irvine, CA, USA). In this paper the studies published to date evaluating these two bioprosthesis models are reviewed, along with future directions and indications for the target patient population.