Analysis of the characteristics of platelet changes and influencing factors after transcatheter aortic valve implantation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Xiangyu ¹ ,  ZHANG Haibo ² ,  YANG Fangyu ¹ , ZHENG Shuai ² , MENG Fei ² , WANG Shengxun ² , JIAO Yuqing ² , LI Yuehuan ² , WU Kaisheng ² , SHEN Jinglun ²

1. School of Nursing, Capital Medical University, Beijing, 100069, P. R. China;
2. Center for Valve Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P. R. China;

Corresponding author：

ZHANG Haibo, Email: zhanghb2318@163.com; YANG Fangyu, Email: yfykk@163.com

Keywords：

Transcatheter aortic valve implantation; aortic stenosis; platelet; influencing factors

DOI：

10.7507/1007-4848.202303046

Video：

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Objective To analyze the characteristics of platelet changes and their influencing factors during postoperative hospitalization in patients who underwent transcatheter aortic valve implantation (TAVI). Methods The patients who underwent TAVI at Beijing Anzhen Hospital Valve Surgery Center between March 2017 and October 2021 were retrospectively selected. The patients were divided into a self-limiting group and a non-self-limiting group according to the characteristics of postoperative platelet decline. In addition, the general preoperative data, preoperative and postoperative ultrasound data, intraoperative data, and the use of anticoagulant drugs during the postoperative stay in the hospital were compared between the two groups. Results A total of 249 patients were enrolled in this study. There were 175 (70.3%) patients in the self-limiting group, including 100 males and 75 females, and there were 74 (29.7%) patients in the non-self-limiting group, including 43 males and 31 females, with no statistical difference between the two groups (P=0.863). The mean age of patients was 73.11±8.88 years in the self-limiting group and 71.54±10.39 years in the non-self-limiting group (P=0.231). The decline of platelets in the self-limiting group generally occurred on the postoperative day 2 and reached the lowest count on the postoperative day 4, and returned to the baseline level on the postoperative day 5-7, while the platelets in the non-self-limiting group changed by simple rise, fall or irregular fluctuation. Patients in the self-limiting group had severer preoperative aortic stenosis (P<0.001) and used more extracorporeal circulation assistance during surgery (P<0.001). Postoperatively, patients in the self-limiting group were more likely to have periaortic valve leakage than those in the non-self-limiting group (P=0.013). Conclusion Platelet changes in most patients after TAVI show a self-limiting decline, which may be related to the severity of patients’ preoperative aortic stenosis, intraoperative extracorporeal circulation device use, and postoperative perivalvular leakage.

Citation： LI Xiangyu, ZHANG Haibo, YANG Fangyu, ZHENG Shuai, MENG Fei, WANG Shengxun, JIAO Yuqing, LI Yuehuan, WU Kaisheng, SHEN Jinglun. Analysis of the characteristics of platelet changes and influencing factors after transcatheter aortic valve implantation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(6): 832-837. doi: 10.7507/1007-4848.202303046 Copy

1.	Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med, 2011, 364(23): 2187-2198.
2.	Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
3.	Reardon MJ, Kleiman NS, Adams DH, et al. Outcomes in the randomized CoreValve US pivotal high risk trial in patients with a Society of Thoracic Surgeons risk score of 7% or less. JAMA Cardiol, 2016, 1(8): 945-949.
4.	Makkar RR, Thourani VH, Mack MJ, et al. Five-year outcomes of transcatheter or surgical aortic-valve replacement. N Engl J Med, 2020, 382(9): 799-809.
5.	Dvir D, Généreux P, Barbash IM, et al. Acquired thrombocytopenia after transcatheter aortic valve replacement: Clinical correlates and association with outcomes. Eur Heart J, 2014, 35(38): 2663-2671.
6.	Flaherty MP, Mohsen A, Moore JB, et al. Predictors and clinical impact of pre-existing and acquired thrombocytopenia following transcatheter aortic valve replacement. Catheter Cardiovasc Interv, 2015, 85(1): 118-129.
7.	McCabe JM, Huang PH, Riedl LA, et al. Incidence and implications of idiopathic thrombocytopenia following transcatheter aortic valve replacement with the Edwards Sapien(©) valves: A single center experience. Catheter Cardiovasc Interv, 2014, 83(4): 633-641.
8.	Hurwitz B, Vass A. What's a good doctor, and how can you make one? BMJ, 2002, 325(7366): 667-668.
9.	Kolte D, Vlahakes GJ, Palacios IF, et al. Transcatheter versus surgical aortic valve replacement in low-risk patients. J Am Coll Cardiol, 2019, 74(12): 1532-1540.
10.	Takahashi S, Yokoyama N, Watanabe Y, et al. Predictor and mid-term outcome of clinically significant thrombocytopenia after transcatheter aortic valve selection. Circ J, 2020, 84(6): 1020-1027.
11.	Grube E, Laborde JC, Gerckens U, et al. Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: The Siegburg first-in-man study. Circulation, 2006, 114(15): 1616-1624.
12.	Gallet R, Seemann A, Yamamoto M, et al. Effect of transcatheter (via femoral artery) aortic valve implantation on the platelet count and its consequences. Am J Cardiol, 2013, 111(11): 1619-1624.
13.	Houston DS. The riddle of thrombocytopenia following transcatheter aortic valve implantation. Thromb Res, 2017, 156: 193-194.
14.	Takagi H, Hari Y, Nakashima K, et al. Impact of postprocedural thrombocytopenia on mortality after transcatheter aortic valve implantation. J Cardiovasc Med (Hagerstown), 2020, 21(4): 318-324.
15.	Jilaihawi H, Doctor N, Chakravarty T, et al. Major thrombocytopenia after balloon-expandable transcatheter aortic valve replacement: Prognostic implications and comparison to surgical aortic valve replacement. Catheter Cardiovasc Interv, 2015, 85(1): 130-137.
16.	Moake JL, Turner NA, Stathopoulos NA, et al. Involvement of large plasma von Willebrand factor (vWF) multimers and unusually large vWF forms derived from endothelial cells in shear stress-induced platelet aggregation. J Clin Invest, 1986, 78(6): 1456-1461.
17.	Van Belle E, Rauch A, Vincent F, et al. Von Willebrand factor multimers during transcatheter aortic-valve replacement. N Engl J Med, 2016, 375(4): 335-344.
18.	Rihal CS, Sorajja P, Booker JD, et al. Principles of percutaneous paravalvular leak closure. JACC Cardiovasc Interv, 2012, 5(2): 121-130.
19.	邢超凡, 潘欣, 何奔. 外科瓣膜置换术后瓣周漏相关性溶血的机制探讨及介入治疗进展. 中国介入心脏病学杂志, 2023, 31(2): 142-145.
20.	Hernández-Enríquez M, Regueiro A, Romaguera R, et al. Thrombocytopenia after transcatheter aortic valve implantation. A comparison between balloon-expandable and self-expanding valves. Catheter Cardiovasc Interv, 2019, 93(7): 1344-1351.
21.	Hernández-Enríquez M, Chollet T, Bataille V, et al. Comparison of the frequency of thrombocytopenia after transfemoral transcatheter aortic valve implantation between balloon-expandable and self-expanding valves. Am J Cardiol, 2019, 123(7): 1120-1126.
22.	Jiritano F, Cristodoro L, Malta E, et al. Thrombocytopenia after sutureless aortic valve implantation: Comparison between Intuity and Perceval bioprostheses. J Thorac Cardiovasc Surg, 2016, 152(6): 1631-1633.
23.	Nobili M, Sheriff J, Morbiducci U, et al. Platelet activation due to hemodynamic shear stresses: Damage accumulation model and comparison to in vitro measurements. ASAIO J, 2008, 54(1): 64-72.
24.	Sedaghat A, Falkenberg N, Sinning JM, et al. TAVI induces an elevation of hemostasis-related biomarkers, which is not causative for post-TAVI thrombocytopenia. Int J Cardiol, 2016, 221: 719-725.
25.	Sexton TR, Wallace EL, Chen A, et al. Thromboinflammatory response and predictors of outcomes in patients undergoing transcatheter aortic valve replacement. J Thromb Thrombolysis, 2016, 41(3): 384-393.
26.	Zhu Q, Liu X, He W, et al. Predictors of thrombocytopenia after self-expandable transcatheter aortic valve replacement: A single-center experience from China. Cardiology, 2018, 139(3): 151-158.

1. Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med, 2011, 364(23): 2187-2198.
2. Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
3. Reardon MJ, Kleiman NS, Adams DH, et al. Outcomes in the randomized CoreValve US pivotal high risk trial in patients with a Society of Thoracic Surgeons risk score of 7% or less. JAMA Cardiol, 2016, 1(8): 945-949.
4. Makkar RR, Thourani VH, Mack MJ, et al. Five-year outcomes of transcatheter or surgical aortic-valve replacement. N Engl J Med, 2020, 382(9): 799-809.
5. Dvir D, Généreux P, Barbash IM, et al. Acquired thrombocytopenia after transcatheter aortic valve replacement: Clinical correlates and association with outcomes. Eur Heart J, 2014, 35(38): 2663-2671.
6. Flaherty MP, Mohsen A, Moore JB, et al. Predictors and clinical impact of pre-existing and acquired thrombocytopenia following transcatheter aortic valve replacement. Catheter Cardiovasc Interv, 2015, 85(1): 118-129.
7. McCabe JM, Huang PH, Riedl LA, et al. Incidence and implications of idiopathic thrombocytopenia following transcatheter aortic valve replacement with the Edwards Sapien(©) valves: A single center experience. Catheter Cardiovasc Interv, 2014, 83(4): 633-641.
8. Hurwitz B, Vass A. What's a good doctor, and how can you make one? BMJ, 2002, 325(7366): 667-668.
9. Kolte D, Vlahakes GJ, Palacios IF, et al. Transcatheter versus surgical aortic valve replacement in low-risk patients. J Am Coll Cardiol, 2019, 74(12): 1532-1540.
10. Takahashi S, Yokoyama N, Watanabe Y, et al. Predictor and mid-term outcome of clinically significant thrombocytopenia after transcatheter aortic valve selection. Circ J, 2020, 84(6): 1020-1027.
11. Grube E, Laborde JC, Gerckens U, et al. Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: The Siegburg first-in-man study. Circulation, 2006, 114(15): 1616-1624.
12. Gallet R, Seemann A, Yamamoto M, et al. Effect of transcatheter (via femoral artery) aortic valve implantation on the platelet count and its consequences. Am J Cardiol, 2013, 111(11): 1619-1624.
13. Houston DS. The riddle of thrombocytopenia following transcatheter aortic valve implantation. Thromb Res, 2017, 156: 193-194.
14. Takagi H, Hari Y, Nakashima K, et al. Impact of postprocedural thrombocytopenia on mortality after transcatheter aortic valve implantation. J Cardiovasc Med (Hagerstown), 2020, 21(4): 318-324.
15. Jilaihawi H, Doctor N, Chakravarty T, et al. Major thrombocytopenia after balloon-expandable transcatheter aortic valve replacement: Prognostic implications and comparison to surgical aortic valve replacement. Catheter Cardiovasc Interv, 2015, 85(1): 130-137.
16. Moake JL, Turner NA, Stathopoulos NA, et al. Involvement of large plasma von Willebrand factor (vWF) multimers and unusually large vWF forms derived from endothelial cells in shear stress-induced platelet aggregation. J Clin Invest, 1986, 78(6): 1456-1461.
17. Van Belle E, Rauch A, Vincent F, et al. Von Willebrand factor multimers during transcatheter aortic-valve replacement. N Engl J Med, 2016, 375(4): 335-344.
18. Rihal CS, Sorajja P, Booker JD, et al. Principles of percutaneous paravalvular leak closure. JACC Cardiovasc Interv, 2012, 5(2): 121-130.
19. 邢超凡, 潘欣, 何奔. 外科瓣膜置换术后瓣周漏相关性溶血的机制探讨及介入治疗进展. 中国介入心脏病学杂志, 2023, 31(2): 142-145.
20. Hernández-Enríquez M, Regueiro A, Romaguera R, et al. Thrombocytopenia after transcatheter aortic valve implantation. A comparison between balloon-expandable and self-expanding valves. Catheter Cardiovasc Interv, 2019, 93(7): 1344-1351.
21. Hernández-Enríquez M, Chollet T, Bataille V, et al. Comparison of the frequency of thrombocytopenia after transfemoral transcatheter aortic valve implantation between balloon-expandable and self-expanding valves. Am J Cardiol, 2019, 123(7): 1120-1126.
22. Jiritano F, Cristodoro L, Malta E, et al. Thrombocytopenia after sutureless aortic valve implantation: Comparison between Intuity and Perceval bioprostheses. J Thorac Cardiovasc Surg, 2016, 152(6): 1631-1633.
23. Nobili M, Sheriff J, Morbiducci U, et al. Platelet activation due to hemodynamic shear stresses: Damage accumulation model and comparison to in vitro measurements. ASAIO J, 2008, 54(1): 64-72.
24. Sedaghat A, Falkenberg N, Sinning JM, et al. TAVI induces an elevation of hemostasis-related biomarkers, which is not causative for post-TAVI thrombocytopenia. Int J Cardiol, 2016, 221: 719-725.
25. Sexton TR, Wallace EL, Chen A, et al. Thromboinflammatory response and predictors of outcomes in patients undergoing transcatheter aortic valve replacement. J Thromb Thrombolysis, 2016, 41(3): 384-393.
26. Zhu Q, Liu X, He W, et al. Predictors of thrombocytopenia after self-expandable transcatheter aortic valve replacement: A single-center experience from China. Cardiology, 2018, 139(3): 151-158.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of the characteristics of platelet changes and influencing factors after transcatheter aortic valve implantation

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