Thrombocytopenia Associated with Perceval Sutureless Aortic Valve Replacement in Elderly Patients: A Word of Caution

2015 ◽  
Vol 18 (3) ◽  
pp. 093 ◽  
Author(s):  
Turki B. Albacker
Keyword(s):  
Aortic Valve ◽  
Elderly Patients ◽  
Blood Cells ◽  
Slow Recovery ◽  
Aortic Valves ◽  
Significant Drop ◽  
Extreme Caution ◽  
Packed Red Blood Cells ◽  
Transfusion Requirements ◽  
First Time

<p class="p1"><span class="s1"><strong>Objective:</strong> The aim of this study was to report for the first time the phenomenon of thrombocytopenia associated with the use of sutureless aortic valve replacements (AVR), and try to find an explanation for its occurrence.</span></p><p class="p1"><span class="s2"><strong>Methods:</strong> The data was collected retrospectively for all patients who had sutureless AVR (7 patients) and was compared to patients who underwent sutured AVR (22 patients) by the same surgeon between February 2012 and November 2013. </span></p><p class="p1"><span class="s1"><strong>Results:</strong> Cardiopulmonary bypass and cross-clamp durations were shorter in the sutureless group (96.4 min, <br /> 70.6 min) compared to the sutured group (128.3 min, 97.3 min), <br /> (<em>P</em> = .04, <em>P</em> = .003) respectively. Mean transvalvular gradients were lower in the sutureless group (mean = 9.6 mmHg) compared to the sutured group (mean = 17.3 mmHg). Platelet levels were significantly lower in the Perceval patients compared to the Enable patients and sutured valves. Platelet transfusion was higher for sutureless valves (6.5 units versus 5.4 units for the sutured group, <em>P</em> = .63), especially the Perceval valve (7.6 units versus 5.3 for the Enable valve, <em>P</em> = .35), but was not statistically significant. Packed red blood cells (PRBCs) transfusion was significantly higher in the sutureless group (6 units versus 3.1 for the sutured group, <em>P</em> = .002). </span></p><p class="p1"><span class="s1"><strong>Conclusion:</strong> The implantation of sutureless aortic valves, especially the Perceval valve, was associated with a significant drop in platelet count postoperatively with slow recovery and higher PRBCs transfusion requirements. Extreme caution should be taken before the routine use of these valves in elderly patients who are already at risk of thrombocytopenia postoperatively. </span></p>

scholarly journals Application of Hyperelastic Nodal Force Method to Evaluation of Aortic Valve Cusps Coaptation: Thin Shell vs. Membrane Formulations

Mathematics ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1450
Author(s):  
Yuri Vassilevski ◽  
Alexey Liogky ◽  
Victoria Salamatova
Keyword(s):  
Aortic Valve ◽  
Finite Elements ◽  
Shell Model ◽  
Thin Shell ◽  
Aortic Valves ◽  
Shear Moduli ◽  
Force Method ◽  
Elastic Potentials ◽  
Shell Analysis ◽  
First Time

Coaptation characteristics are crucial in an assessment of the competence of reconstructed aortic valves. Shell or membrane formulations can be used to model the valve cusps coaptation. In this paper we compare both formulations in terms of their coaptation characteristics for the first time. Our numerical thin shell model is based on a combination of the hyperelastic nodal forces method and the rotation-free finite elements. The shell model is verified on several popular benchmarks for thin-shell analysis. The relative error with respect to reference solutions does not exceed 1–2%. We apply our numerical shell and membrane formulations to model the closure of an idealized aortic valve varying hyperelasticity models and their shear moduli. The coaptation characteristics become almost insensitive to elastic potentials and sensitive to bending stiffness, which reduces the coaptation zone.

scholarly journals The use of RemoweLL oxygenator-integrated device in the prevention of the complications related to aortic valve surgery in the elderly patient: Preliminary results

2018 ◽  
Vol 25 (1_suppl) ◽  
pp. 59-65
Author(s):  
Alberto Molardi ◽  
Maria V Di Chicco ◽  
Davide Carino ◽  
Matteo Goldoni ◽  
Matteo Ricci ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Valve ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Interleukin 6 ◽  
Blood Cells ◽  
White Blood Cells ◽  
Lower Amount ◽  
Parametric Data ◽  
Group B

Background The effects of fat microembolization due to cardiopulmonary bypass are well known in cardiac surgery. Our aim is to evaluate the use of the RemoweLL device (Eurosets, Medolla, Italy) during elective aortic valve replacement in elderly patients (>70 years old) to rate its biochemical and clinical effects. The RemoweLL device is an oxygenator-integrated reservoir which combines two strategies for fat emboli and leucocytes removal: filtration and supernatant elimination. Methods Forty-four elderly patients were enrolled and assigned randomly to a Group A (standard device) and a Group B (RemoweLL). Biochemical effects were evaluated by blood samples, which were tested for white blood cells, neutrophils, protein SP-100 and interleukin 6 besides standard lab tests. Our clinical endpoints were any type of neurological, cardiac, respiratory, gastrointestinal or renal complications, and length of stay in the intensive care unit. Statistical analysis was carried out with chi square test for non-parametric data; t test and analysis of variance for repeated measures were used for parametric data. Results Group B showed lower levels of white blood cells, neutrophils, interleukin 6 and protein SP-100 immediately and 24 hours after the operation. Group B also showed a lower amount of neurocognitive type II dysfunction even if the length of stay in the ICU did not change. Conclusions The RemoweLL system is safe and effective in reducing inflammatory response to cardiopulmonary bypass and it could be a useful tool in minimizing negative effects of cardiopulmonary bypass; however, it does not seem to have any effect on elderly patients’ hospital stay.

scholarly journals Reduction in blood product transfusion requirements with early on-ECMO repair of congenital diaphragmatic hernia

2022 ◽  
Vol 18 (1) ◽  
Author(s):  
Stephen M. Niemiec ◽  
Amanda E. Louiselle ◽  
Ryan Phillips ◽  
Sarah A. Hilton ◽  
Sarkis C. Derderian ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Blood Cells ◽  
Blood Product ◽  
Bleeding Risk ◽  
Blood Product Transfusion ◽  
Early Repair ◽  
Packed Red Blood Cells ◽  
Operative Repair ◽  
Transfusion Requirements

Abstract Background For infants with severe congenital diaphragmatic hernia (CDH) stabilized with extracorporeal membrane oxygenation (ECMO), early repair on ECMO improves outcome; however when compared to operative repair after ECMO, repair on ECMO is associated with increase bleeding risk and need for blood product transfusions. Methods A retrospective review of 54 patients with CDH placed on ECMO prior to CDH repair was performed. For the subset of patients repaired on ECMO, analysis comparing those repaired early (within 48 h of cannulation) and late (beyond 48 h) on ECMO was performed. Outcomes of interest included survival to discharge, days on ECMO, and postoperative blood product utilization. Results When compared to those patients repaired prior to 48 h of ECMO initiation, 57.7% of patients survived versus 40.9% of late repair patients. For those repaired early, blood product utilization was significantly less. Early repair patients received a median of 72 mL/kg packed red blood cells (PRBC) and 75 mL/kg platelets compared to 151.9 mL/kg and 98.7 mL/kg, respectively (p < 0.05 respectively). There was no difference in median days on ECMO (p = 0.38). Conclusion Our data supports prior reports of improved outcome with repair with 48 h of ECMO initiation and suggests early repair on ECMO is associated with less bleeding and decreased blood product requirement in the postoperative period.

scholarly journals Comparison of the hemostatic effects of fresh whole blood, stored whole blood, and components after open heart surgery in children

Blood ◽  
1991 ◽  
Vol 77 (5) ◽  
pp. 930-936
Author(s):  
CS Manno ◽  
KW Hedberg ◽  
HC Kim ◽  
GR Bunin ◽  
S Nicolson ◽  
...  
Keyword(s):  
Platelet Aggregation ◽  
Blood Loss ◽  
Red Blood Cells ◽  
Whole Blood ◽  
Blood Cells ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Packed Red Blood Cells ◽  
Transfusion Requirements

In a double-blind study, we compared the postoperative (post-op) blood loss in 161 children undergoing open heart surgery with cardiopulmonary bypass whose immediate post-op transfusion requirements were met with either very fresh whole blood (VFWB), 24- to 48-hour-old whole blood or reconstituted whole blood (packed red blood cells, fresh frozen plasma [FFP], and platelets). Assignment to treatment groups was not strictly random but dependent, in part, on the ability of families to provide directed donors for fresh blood. The three patient groups were comparable with respect to patient age, pre-op coagulation profiles (bleeding time, prothrombin time, activated partial thromboplastin time, platelet count, fibrin split products, fibrinogen, and platelet aggregation tests) difficulty of operative procedures and time spent on CPB. Mean 24-hour post-op blood loss in milliliters per kilogram was 50.9 +/- 9.3 in the VFWB group, 44.8 +/- 6.0 in the 24- to 48-hour-old group, and 74.2 +/- 8.9 in the reconstituted group (p = .03). When blood loss was compared in the 93 children less than 2 years of age, mean blood loss was 52.3 +/- 10.8 in the VFWB group, 51.7 +/- 7.4 in the 24- to 48-hour-old group, and 96.2 +/- 10.7 in the reconstituted group (P = .001). For subjects who had received reconstituted blood, 30- minute and 3-hour post-op platelet aggregation responses to adenosine diphosphate (10 mumol/L) and 30-minute aggregation response to epinephrine (2.5 mumol/L) were more depressed than in the VFWB and 24- to 48-hour groups (P less than .001, P = .005, and P = .02). Comparison of other post-op coagulation tests could not explain the increased blood loss in the reconstituted group. We conclude that the transfusion of less than 48 hours old whole blood is associated with significantly less post-op blood loss than the transfusion of packed red blood cells, FFP, and platelets in children under 2 years old who underwent complex cardiac surgery. The blood losses associated with the transfusion of VFWB and 24- to 48-hour-old blood are comparable and may be, in part, due to better functioning platelets.

scholarly journals Comparison of the hemostatic effects of fresh whole blood, stored whole blood, and components after open heart surgery in children

Blood ◽  
1991 ◽  
Vol 77 (5) ◽  
pp. 930-936 ◽  
Author(s):  
CS Manno ◽  
KW Hedberg ◽  
HC Kim ◽  
GR Bunin ◽  
S Nicolson ◽  
...  
Keyword(s):  
Platelet Aggregation ◽  
Blood Loss ◽  
Red Blood Cells ◽  
Whole Blood ◽  
Blood Cells ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Packed Red Blood Cells ◽  
Transfusion Requirements

Abstract In a double-blind study, we compared the postoperative (post-op) blood loss in 161 children undergoing open heart surgery with cardiopulmonary bypass whose immediate post-op transfusion requirements were met with either very fresh whole blood (VFWB), 24- to 48-hour-old whole blood or reconstituted whole blood (packed red blood cells, fresh frozen plasma [FFP], and platelets). Assignment to treatment groups was not strictly random but dependent, in part, on the ability of families to provide directed donors for fresh blood. The three patient groups were comparable with respect to patient age, pre-op coagulation profiles (bleeding time, prothrombin time, activated partial thromboplastin time, platelet count, fibrin split products, fibrinogen, and platelet aggregation tests) difficulty of operative procedures and time spent on CPB. Mean 24-hour post-op blood loss in milliliters per kilogram was 50.9 +/- 9.3 in the VFWB group, 44.8 +/- 6.0 in the 24- to 48-hour-old group, and 74.2 +/- 8.9 in the reconstituted group (p = .03). When blood loss was compared in the 93 children less than 2 years of age, mean blood loss was 52.3 +/- 10.8 in the VFWB group, 51.7 +/- 7.4 in the 24- to 48-hour-old group, and 96.2 +/- 10.7 in the reconstituted group (P = .001). For subjects who had received reconstituted blood, 30- minute and 3-hour post-op platelet aggregation responses to adenosine diphosphate (10 mumol/L) and 30-minute aggregation response to epinephrine (2.5 mumol/L) were more depressed than in the VFWB and 24- to 48-hour groups (P less than .001, P = .005, and P = .02). Comparison of other post-op coagulation tests could not explain the increased blood loss in the reconstituted group. We conclude that the transfusion of less than 48 hours old whole blood is associated with significantly less post-op blood loss than the transfusion of packed red blood cells, FFP, and platelets in children under 2 years old who underwent complex cardiac surgery. The blood losses associated with the transfusion of VFWB and 24- to 48-hour-old blood are comparable and may be, in part, due to better functioning platelets.

scholarly journals Impact of Material Stiffness and Anisotropy on Coaptation Characteristics for Aortic Valve Cusps Reconstructed from Pericardium

Mathematics ◽  
2021 ◽  
Vol 9 (18) ◽  
pp. 2193
Author(s):  
Alexey Liogky ◽  
Pavel Karavaikin ◽  
Victoria Salamatova
Keyword(s):  
Aortic Valve ◽  
Diastolic Pressure ◽  
Central Zone ◽  
Aortic Valves ◽  
Material Stiffness ◽  
Numerical Assessment ◽  
Aortic Leaflet ◽  
Membrane Models ◽  
Shell Formulation ◽  
First Time

The numerical assessment of reconstructed aortic valves competence and leaflet design optimization rely on both coaptation characteristics and the diastolic valve configuration. These characteristics can be evaluated by the shell or membrane formulations. The membrane formulation is preferable for surgical aortic valve neocuspidization planning since it is easy to solve. The results on coaptation zone sensitivity to the anisotropy of aortic leaflet material are contradictive, and there are no comparisons of coaptation characteristics based on shell and membrane models for anisotropic materials. In our study, we explore for the first time how the reduced model and anisotropy of the leaflet material affect the coaptation zone and the diastolic configuration of the aortic valve. To this end, we propose the method to mimic the real, sutured neo-leaflet, and apply our numerical shell and membrane formulations to model the aortic valve under the quasi-static diastolic pressure varying material stiffness and anisotropy directions. The shell formulation usually provides a lesser coaptation zone than the membrane formulation, especially in the central zone. The material stiffness does influence the coaptation zone: it is smaller for stiffer material. Anisotropy of the leaflet material does not affect significantly the coaptation characteristics, but can impact the deformed leaflet configuration and produce a smaller displacement.

An Assessment of Ca-Naphthenate-Epon Mixtures as Standards for Calcium Quantification in Aortic Valve Leaflets

1982 ◽  
Vol 40 ◽  
pp. 390-391
Author(s):  
Kathryn N. Colonna ◽  
Sydney S. Breese ◽  
Susan C. Sellers ◽  
J. David Deck
Keyword(s):  
Aortic Valve ◽  
Aortic Valves ◽  
X Ray ◽  
Aortic Valve Leaflets

Qualitative x-ray microanalytical studies used to demonstrate calcium in bioprosthetic aortic valves have shown that it occurs in a range of morphological forms. A consistent and reproducible standard for measuring calcium was necessary to investigate whether these forms represented varying concentrations of calcium. To provide such a standard, we tested a series of calcium naphthenate-epon mixtures.

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