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Platelet function in patients undergoing surgical and transcatheter aortic valve replacement: a comparative study.

BACKGROUND
Intervention-induced platelet hypercoagulability may pose a risk of serious adverse events for patients.


AIMS
The aim of this study was to assess whether surgical (SAVR) and transcatheter aortic valve replacement (TAVR) differ in periprocedural platelet activity.


METHODS
The total number of 24 patients with a mean age (SD) of 71 (13) years who underwent SAVR (n=12) or TAVR (n=12) were recruited for the study. The following parameters were evaluated at four time-points: (i) platelet indices: total platelet count (PLT), platelet distribution width (PDW) and mean platelet volume (MPV), (ii) MPV/PLT ratio, (iii) platelet level of lipid peroxidation: malondialdehyde (MDA) content and MDA/PLT ratio. Eventually, percentage variations of PLT, PDW and MPV in relation to the baseline values were determined.


RESULTS
MPV/PLT ratio increased significantly after procedures in both groups (P = 0.01 in TAVI and P = 0.01 in SAVR). MDA concentrations were significantly higher when assessed directly post-procedure (P = 0.04) as well as 24h later (P = 0.01) in the SAVR and TAVI groups. The indirect parameter of platelet activity indexed for platelet counts (MDA/PLT) was comparable between both groups before and 48 hours after procedures, but was significantly higher in SAVR patients, particularly after 24h after interventions (P = 0.04; medians TAVR vs. SAVR, respectively).


CONCLUSION
Standard surgical aortic valve replacement is associated with a more pronounced platelet reaction to intervention-induced injury, as compared to the transcatheter-based procedure. The importance of these laboratory findings requires further investigation focused on early and late clinical outcomes.