Déjà vu? Evidence for Thrombocytopenia following Implantation of the Perceval S Aortic Bioprosthesis

Objectives: The Perceval S bioprosthesis (LivaNova) is increasingly used, especially in high-risk patients and for minimal invasive aortic valve replacement. The Perceval S is based on the Freedom Solo aortic bioprosthesis which has been reported to be associated with perioperative thrombocytopenia. Whether this phenomenon is also seen with the Perceval S has not systematically studied. We therefore compared platelet counts after aortic valve replacement (AVR) with the Perceval S bioprosthesis to those with other bioprostheses. Furthermore we investigated whether there are differences in the clinical outcome of the patients.

Methods: 87 patients receiving AVR in a 16 months period were included in this retrospective study: 25 patient receiving AVR with the Perceval S, 23 patients with the Labcor TLPB-A and 39 patients with the Medtronic Hancock II bioprosthesis.

Results: Preoperatively there were no differences in platelet counts between Perceval S patients and control groups. After AVR, the minima of the absolute platelet count and of the hematocrit-corrected platelet count were significantly lower in Perceval S patients. The significant difference in platelet counts persisted until discharge or death of the patients. Despite the significant differences in thrombocyte counts, there were no significant differences regarding blood loss, transfusion requirements or the rates of re-thoracotomy.

Table 1 Thrombocyte counts

	LivaNova Perceval S	Labcor TLPB-A	Medtronic Hancock II	p-Value (Kruskal–Wallis)
preoperative	203 ± 64	223 ± 100	238 ± 67	0.228
minimal count	55 ± 23	87 ± 48	85 ± 33	0.001
at discharge/ death	181 ± 90	274 ± 136	323 ± 132	<0.001

Conclusion: After AVR, platelet counts in Perceval S patients drop more severely and platelet recovery is slower compared with recipients of other bioprostheses, but in our small study we found no evidence of a detrimental effect of this phenomena. Further studies have to confirm our finding and investigate its cause.