Heart Valve Replacement In Patients Combined With Thrombocytopenia

Objective: To evaluate the feasibility for patients combined with thrombocytopenia undergoing heart valve replacement and to discuss the appropriate standard of anticoagulation therapy for these patients. Methods: Retrospectively analyzed the clinical data of 18 patients combined with thrombocytopenia undergoing heart valve replacement from Jan 1997 to Dec 2001 in our hospital. There were 12 males and 6 females aged between 24 and 65 years (mean 47.22 ±11.9). Etiologically, there are 11 rheumatic heart diseases, 4 infective endocarditis, two Mafan's syndrome and one deterioration of tissue valve implanted 14 years ago. Their heart function classes were in NYHAII in 6 patients, NYHAIII in 9, NYHAIV in 3, preoperatively.At admission, their platelet count ranged from 23X109.!/1 to SOX 109.!/1 with an average of( 42±7.41)X 109.L"' . The operations were all done through median sternotomy, with membrane oxygenator for cardiopulmonary bypass and cold blood mixed crystalloid cardioplegia for persistent perfusion. 3X106U aprotinin was added into prime solution . Mitral valve replacement was performed in 7 patients, aortic valve replacement in 3 patients, double valves replacement in 8 patients. The simultaneously-performed operations include left atrial thrombus removal in one, tricuspid valvuloplasty in one. 13 to 27 U of platelet(mean 17.76±3.93U) was transfused just at the termination of the cardiopulmonary bypass and heparin reversal by protamine sulfate. Another 90 patients undergoing heart valve replacement in the same period, whose preoperative platelet counts were normal, were enrolled in the control group randomly. Results: The drainage volume in pericardial and mediastinal tube ranges from 215ml to 2560ml with the mean volume as (1016.94 ± 645.87)ml, bank blood requirement ranges from 400ml to 2400ml, the average is (1322.22±553.66)ml. Among all 18 patients, one was re-explored for excessive hemorrhage, one died of ventricular fibrillation 3 days after operation. The follow-up period ranged from 5to 58 months with the mean as (21.85 ± 17.46) months. Among the 17 survived the operation, the average dosage of warfarin is ( 0.0308± 0.0152) mg.kg"1. No thrombosis and severe hemorrhage was observed in this followed-up group except for 2 mild hemorrhage. There is no significant difference in drainage volume of pericardial and mediastinal tube, bank blood requirement, re-exploration rate, mortality, mean in-hospital stay period, oral anticoagulant dosage and complication rate between the two groups.Conclusions: Heart valve replacement can be performed in patients combined with thrombocytopenia if managed appropriately during operation. Routine anticoagulation therapy does not increase their morbidity and mortality.