Perioperative thrombocytopenia after transcatheter versus surgical bioprosthetic aortic valve replacement: a single-center retrospective study

BACKGROUND: Postoperative thrombocytopenia is frequently observed after both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI). However, contemporary real-world data directly comparing the magnitude and temporal pattern of platelet decline between these two interventions remains limited. METHODS: Consecutive patients with severe aortic stenosis who underwent SAVR with a bioprosthesis or TAVI at a single tertiary center between 2017 and 2023 were retrospectively analyzed. Demographic, clinical, echocardiographic, and laboratory data were collected. Platelet counts were recorded at baseline, intraoperatively, and on postoperative days (PODs) 1 and 2. In the SAVR group, the intraoperative platelet count was defined as the measurement obtained immediately after separation from cardiopulmonary bypass and reversal of heparin with protamine. In the TAVI group, the intraoperative value corresponded to the platelet count measured immediately after valve deployment and completion of the procedure. The primary endpoint was perioperative platelet count dynamics across predefined time points. RESULTS: A total of 248 patients were included (SAVR, n = 132; TAVI, n = 116). Patients undergoing TAVI were significantly older and had higher surgical risk scores, whereas baseline platelet counts were comparable between groups. Baseline platelet counts were comparable between groups. In the SAVR cohort, platelet counts declined sharply intraoperatively and continued to decrease on POD1 and POD2. In contrast, patients treated with TAVI showed a more gradual, moderate platelet reduction. Intergroup differences were significant during the intraoperative and postoperative periods. Although the decline from POD1 to POD2 was less pronounced, it remained statistically significant. CONCLUSIONS: Thrombocytopenia occurs almost universally following aortic valve intervention. SAVR is associated with a more abrupt and sustained decrease in platelet counts, whereas TAVI results in milder reductions, despite being performed in older, higher-risk patients. Close monitoring of platelet dynamics in the early postoperative period may provide clinically relevant insights; however, further studies are required to establish a direct relationship with patient outcomes.