Inselspital University Hospital and University of Berne

Bern, Switzerland

Inselspital University Hospital and University of Berne

Bern, Switzerland
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PubMed | University of Graz, Saint John of God Hospital, Inselspital University Hospital and University of Berne and Paracelsus Medical University
Type: Journal Article | Journal: Heart, lung & circulation | Year: 2016

Use of the Freedom SOLO (FS) stentless aortic bioprosthesis is limited by a unique and as yet unexplained severe decrease in postoperative platelet count in the absence of FS-related excess bleeding or thromboembolism. We investigated whether anticoagulant-associated pseudothrombocytopaenia could explain this complication.Thirty consecutive patients (mean age 75.47.7 years, 11 [36.7%] female) underwent elective aortic valve replacement (AVR) with either the stented bovine Mitroflow (MF, n=18) or the stentless bovine FS (n=12) aortic valve bioprostheses. Serial platelet counts were performed simultaneously with sampling tubes containing tripotassium (KPostoperative platelet counts decreased compared with preoperative values in all patients (p<0.001), but were significantly lower in patients receiving FS compared to MF at all measurement time points until the end of observation (day 9). Lowest platelet counts were seen on the first postoperative day for MF (mean reduction: -41.5%) and on the second postoperative day for FS (mean reduction: -59.9%). Postoperative platelet counts did not correlate with any of the anticoagulants, thereby indicating no pseudothrombocytopaenia in the study population. There was no interaction between anticoagulant and type of valve. Only 1% of variance in platelet counts was caused by the anticoagulant, 46% by the day of measurement relative to baseline, and 20% was caused by the type of valve.The platelet-lowering effect in patients receiving the FS is valve-dependent and is not caused by systemic preanalytical (laboratory) measurement error such as anticoagulant-dependent pseudothrombocytaemia, particularly with EDTA and citrate.


Thalmann M.,Hietzing Hospital | Kaiblinger J.,Hietzing Hospital | Krausler R.,Paracelsus Medical University | Pisarik H.,Hietzing Hospital | And 6 more authors.
Annals of Thoracic Surgery | Year: 2014

Results. The overall 30-day mortality was 4.3%. Themortalities for isolated AVR and combined procedureswere 1.9% and 7.3%, respectively. No causes of death werevalve-related. Preoperative peak (74.2 ± 23.0 mm Hg) andmean (48.6 ± 16.3 mm Hg) gradients decreased to15.6 ± 5.4 mm Hg and 8.8 ± 3.0 mm Hg postoperativelyand remained unchanged for as long as 5 years. Thepostoperative mean effective orifice area (EOA) for valvesizes 19, 21, 23, 25, and 27 were 1.49 ± 0.32 cm2, 1.67 ±0.40 cm2, 1.92 ± 0.38 cm2, 2.01 ± 0.42 cm2, and 2.13 ± 0.36 cm2,respectively. Severe prosthesis-patient mismach (PPM)was completely absent, and moderate PPM occurred in17 patients (6.1%). In isolated AVR, 0.8% of patients withpreoperative sinus rhythm required a permanent pacemakerbefore hospital discharge. There was 100% freedomfrom structural valve deterioration, 99.6 % freedom fromendocarditis and reoperation, and 97.3% freedom fromthromboembolism at 5 years.Background. The Sorin Freedom SOLO (FS) bovinepericardial stentless valve prosthesis is designed forsupraannular, subcoronary implantation. We report ourexperience and results with 277 consecutively implantedFS bioprostheses.Methods. 277 patients (mean age, 74.2 ± 7.3 years; 139(50.2%) female) underwent aortic valve replacement (AVR)with the FS stentless bioprosthesis. The hemodynamic performancewas investigated with transthoracic echocardiographyat discharge, 6 months later, and yearly thereafter.Follow-up was 100% complete, with an average observationtime of 2.6 ± 1.7 years and a total of 697.3 patient-years.Conclusions. The FS stentless aortic valve is safe toimplant, and it shows excellent hemodynamic performanceand early and midterm results. Owing to thefavorable EOA, the valve appears particularly attractivefor patients at risk for PPM. © 2014 by The Society of Thoracic Surgeons.


PubMed | Paracelsus Medical University, Hietzing Hospital and Inselspital University Hospital and University of Berne
Type: Journal Article | Journal: The Annals of thoracic surgery | Year: 2014

The Sorin Freedom SOLO (FS) bovine pericardial stentless valve prosthesis is designed for supraannular, subcoronary implantation. We report our experience and results with 277 consecutively implanted FS bioprostheses.277 patients (mean age, 74.2 7.3 years; 139 (50.2%) female) underwent aortic valve replacement (AVR) with the FS stentless bioprosthesis. The hemodynamic performance was investigated with transthoracic echocardiography at discharge, 6 months later, and yearly thereafter. Follow-up was 100% complete, with an average observation time of 2.6 1.7 years and a total of 697.3 patient-years.The overall 30-day mortality was 4.3%. The mortalities for isolated AVR and combined procedures were 1.9% and 7.3%, respectively. No causes of death were valve-related. Preoperative peak (74.2 23.0 mm Hg) and mean (48.6 16.3 mm Hg) gradients decreased to 15.65.4mm Hg and 8.8 3.0 mm Hg postoperatively andremained unchanged for as long as 5 years. The postoperative mean effective orifice area (EOA) for valve sizes 19, 21, 23,25, and 27 were 1.49 0.32 cm(2), 1.67 0.40cm(2), 1.920.38cm(2), 2.01 0.42 cm(2), and 2.13 0.36 cm(2), respectively. Severe prosthesis-patient mismach (PPM) was completely absent, and moderate PPM occurred in 17patients (6.1%). In isolated AVR, 0.8% of patients with preoperative sinus rhythm required a permanent pacemaker before hospital discharge. There was 100% freedom from structural valve deterioration, 99.6 % freedom from endocarditis and reoperation, and 97.3% freedom from thromboembolism at 5 years.The FS stentless aortic valve is safe to implant, and it shows excellent hemodynamic performance and early and midterm results. Owing to the favorable EOA, the valve appears particularly attractive for patients at risk for PPM.

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