March 15, 2021Open Access

Thrombocytopenia Complicating Transcatheter Aortic Valve Implantation: Differences Between Two New-Generation Devices

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Severe aortic valve stenosis (n=238). Intervention: Portico transcatheter aortic valve vs. Evolut transcatheter aortic valve. Primary outcome: Normalized platelet count at 3 days post-implantation.

NCNicola CorcioneInterventional Cardiology SRSimona RomanoFederico II University Hospital AMAlberto MorelloVilla Pineta Hospital

Key Result

Portico valve recipients experienced a more profound drop in normalized platelet counts at 3 days post-implantation compared to Evolut recipients (60.2 vs 71.8), which was mitigated by extra rinsing of the storage solution.

Study Design

Type

Observational (n=238)

Multicenter

Structured PICO

Does the choice of transcatheter aortic valve device (Portico vs Evolut) affect periprocedural platelet damage and pro-inflammatory state in TAVI recipients?

Population

64 TAVI recipients

Intervention

Portico transcatheter aortic valve implantation (with or without additional flushing of storage solution)

Comparator

Evolut transcatheter aortic valve implantation

Outcome

Periprocedural platelet damage and/or pro-inflammatory state (assessed by annexin V staining, monocyte-phagocytic phenotype, and serum cytokines)surrogate

The formaldehyde-based storage solution of the Portico valve may cause platelet injury and thrombocytopenia, which can be mitigated by additional flushing prior to implantation.

Main Result

Absolute Event Rate: 60.2% vs 71.8%

Limitations

Non-randomized nature of the registry leading to selection bias
Choice of device type, procedural strategy, and periprocedural management were left to the physician's discretion
Not powered for clinical outcomes evaluation

Abstract

Thrombocytopenia after TAVI is common and clinically detrimental. Retrospectively, we observed Portico recipients had a more profound platelet drop than Evolut recipients. We thus investigated periprocedural platelet damage and/orpro-inflammatory state in 64 TAVI recipients at baseline and after implantation. Platelet damage was assessed by annexin V staining and monocyte-phagocytic phenotype was assessed according to CD14/CD36 expression. Serum cytokines were measured in 20 patients. The formaldehyde-based storage solution altered platelets. When, before being loaded onto the delivery system, Portico underwent one additional flushing to those recommended, the receiving patients showed thrombocytopenia, platelet damage, and CD36-monocyte count were mitigated. A general increase in IL-6 was recorded in overall TAVI recipients, but a high serum level of IL-8, a potent thrombocytopenia inducer, was measured in Portico recipients only, including those with extra-rinsed valve. Our study suggests a platelet-injury effect by storage-solution and generates the hypothesis of a role for the biomaterial in stimulating innate-immunity. Larger prospective studies are needed. Graphical Abstract.

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Cite This Study

Corcione et al. (Mon,) conducted a observational in Severe aortic valve stenosis (n=238). Portico transcatheter aortic valve vs. Evolut transcatheter aortic valve was evaluated on Normalized platelet count at 3 days post-implantation. Portico valve recipients experienced a more profound drop in normalized platelet counts at 3 days post-implantation compared to Evolut recipients (60.2 vs 71.8), which was mitigated by extra rinsing of the storage solution.

synapsesocial.com/papers/6a0f9ff4e3460f6d4c1cd587 https://doi.org/https://doi.org/10.1007/s12265-021-10117-9

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