Background Postprocedural thrombocytopenia is a known phenomenon following transcatheter aortic valve implantation (TAVI). The aim of this study is to evaluate whether postinterventional platelet kinetics differ when comparing the current generation of balloon-expandable valve (BEV) and self-expanding valve (SEV) prostheses. Methods We performed a retrospective analysis of patients undergoing TAVI at our facility between 2017 and 2019. Patients were stratified according to the type of prosthesis used: BEV or SEV. Hematocrit-corrected platelet counts were calculated to account for dilution. Nadir platelet counts (lowest recorded platelet count), drop platelet counts (DPC; highest relative platelet drop from baseline), and severity of thrombocytopenia during the discourse and at discharge were assessed. Results Of the 277 included patients, 212 received SEV and 65 BEV. BEV patients were younger (81.8 ± 4.4 years vs 79.7 ± 6.8 years, p = 0.03). Further demographic characteristics were similar between groups. Implanted SEV were larger (p < 0.001) and had shorter procedural times (p < 0.01). There were no significant differences in postprocedural discourse. Postinterventional platelet drop was more pronounced in BEV patients in several evaluated metrics: mean DPC (24.3 ± 10.9% vs 18.8 ± 14.8%, p < 0.01), patients with DPC > 30% (n = 19, 29.2%, vs n = 33, 15.6%, p = 0.02), and also when comparing platelet kinetics. Conclusion Despite improvements in outcome, the current generation of balloon-expandable TAVI prostheses carries a predisposition for postprocedural thrombocytopenia even when the effects of dilution are accounted for.

中文翻译：

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现代经导管主动脉瓣置换术中的获得性血小板减少症

背景 术后血小板减少症是经导管主动脉瓣植入 (TAVI) 后的一种已知现象。本研究的目的是评估在比较当前一代球囊扩张瓣膜 (BEV) 和自扩张瓣膜 (SEV) 假体时，介入后血小板动力学是否存在差异。方法 我们对 2017 年至 2019 年间在我们机构接受 TAVI 的患者进行了回顾性分析。根据使用的假体类型对患者进行分层：BEV 或 SEV。计算血细胞比容校正血小板计数以考虑稀释。评估最低血小板计数（记录的最低血小板计数）、下降血小板计数（DPC；相对于基线的最高相对血小板下降）以及治疗期间和出院时血小板减少症的严重程度。结果 在 277 名患者中，212 名接受了 SEV，65 名接受了 BEV。 BEV 患者更年轻（81.8±4.4 岁 vs 79.7±6.8 岁，p=±0.03）。各组之间的进一步人口统计特征相似。植入的SEV更大(p＜＜0.001)并且具有更短的手术时间(p＜＜0.01)。术后话语没有显着差异。在几个评估指标中，BEV 患者的干预后血小板下降更为明显：平均 DPC（24.3±10.9% vs 18.8±14.8%，p＜0.01），DPC 患者30%（n = 19, 29.2%，vs n = 33, 15.6%，p = 0.02），并且在比较血小板动力学时也是如此。结论 尽管结果有所改善，但即使考虑到稀释的影响，当前一代的球囊扩张 TAVI 假体仍容易出现术后血小板减少症。