Thrombocytopenia in Moderate- to High-Risk Sutureless Aortic Valve Replacement
´ëÇÑÈäºÎ¿Ü°úÇÐȸÁö 2018³â 51±Ç 3È£ p.172 ~ p.179
(Thitivaraporn Puwadon) - King Chulalongkorn Memorial Hospital Cardiovascular and Thoracic Surgery Unit
(Chiramongkol Sarun) - King Chulalongkorn Memorial Hospital Cardiovascular and Thoracic Surgery Unit
(Muntham Dittapol) - Rajamangala University of Technology Suvarnabhumi Faculty of Science and Technology Section of Mathematic
(Pornpatrtanarak Nopporn) - King Chulalongkorn Memorial Hospital Cardiovascular and Thoracic Surgery Unit
(Kittayarak Chanapong) - King Chulalongkorn Memorial Hospital Cardiovascular and Thoracic Surgery Unit
(Namchaisiri Jule) - King Chulalongkorn Memorial Hospital Cardiovascular and Thoracic Surgery Unit
(Singhatanadgige Seri) - King Chulalongkorn Memorial Hospital Cardiovascular and Thoracic Surgery Unit
(Ongcharit Pat) - King Chulalongkorn Memorial Hospital Cardiovascular and Thoracic Surgery Unit
(Benjacholamas Vichai) - King Chulalongkorn Memorial Hospital Cardiovascular and Thoracic Surgery Unit
Abstract
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/¥ìL preoperatively to 94.5, 54.5, and 50.1¡¿103/¥ìL 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.
Å°¿öµå
Sutureless valve replacement, Moderate to high risk patient, Postoperative thrombocytopenia, Aortic valve replacement
¿ø¹® ¹× ¸µÅ©¾Æ¿ô Á¤º¸
µîÀçÀú³Î Á¤º¸
À¯È¿¼º°á°ú(Recomendation)
In moderate- to high-risk patients. SU-AVR was associated with a reduction in the mean cross-clamp time of 30.5 minutes (25.6% relative reduction) and the CPB time was also reduced by 28 minutes (18.9% relative reduction); r small STS PROM matching analysis showed the disadvantage of postoperative thrombocytopenia, requiring transfusion of more blood and blood components.