Perioperative Thrombocytopenia After Transcatheter Versus Surgical Bioprosthetic Aortic Valve Replacement: A Single-Center Retrospective Study

Perioperative Thrombocytopenia After Transcatheter Versus Surgical Bioprosthetic Aortic Valve Replacement: A Single-Center Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Perioperative Thrombocytopenia After Transcatheter Versus Surgical Bioprosthetic Aortic Valve Replacement: A Single-Center Retrospective Study ÖZKAN KARACA, Mehmet Erin Tüysüz, Ferruh Elbir, Vehbi Kınay, Kemal Göçer This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8418122/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract 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, immediately after the procedure, and on postoperative days (PODs) 1 and 2. The primary endpoint was a ≥ 50% reduction in platelet count relative to baseline. 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 hospital stay was shorter compared with the SAVR group. 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 help optimize clinical management. Thrombocytopenia Surgical aortic valve replacement Transcatheter aortic valve implantation Bioprosthetic valve Platelet dynamics Figures Figure 1 Background Severe aortic stenosis (AS) is one of the most common valvular heart diseases in elderly individuals and is associated with substantial morbidity and mortality when left untreated. SAVR with a bioprosthesis has long represented the standard therapy. In recent years, TAVI has emerged as a less invasive alternative, initially reserved for high-risk patients but increasingly adopted across the full spectrum of surgical risk categories [ 1 ]. Hematological complications remain clinically relevant following valve replacement. Among these, thrombocytopenia is a well-recognized phenomenon after both SAVR and TAVI. The underlying mechanisms are multifactorial: in SAVR, platelet activation and consumption are linked to cardiopulmonary bypass (CPB), hemodilution, and systemic anticoagulation; in TAVI, factors such as shear stress, blood–device interactions, and prosthesis-related effects may contribute [ 2 , 3 ]. Although often transient and asymptomatic, significant thrombocytopenia may predispose patients to bleeding events, transfusion requirements, or other adverse outcomes. Prior reports have produced inconsistent findings. Some studies indicate that SAVR patients, particularly those receiving stentless or sutureless valves such as the Freedom SOLO or Perceval, experience more profound platelet reductions [ 3 , 4 ]. Conversely, TAVI tends to cause a more gradual decline, although severe thrombocytopenia has been documented and, in some cases, is associated with worse outcomes [ 5 ]. Importantly, there is limited real-world evidence directly comparing these two strategies in the same institutional setting across contemporary practice years. The rationale for comparing preoperative and postoperative day 1 platelet counts in our study stems from recent evidence suggesting that early postoperative thrombocytopenia may serve as a prognostic indicator for bleeding complications, transfusion requirements, and even in-hospital mortality after surgical bioprosthetic aortic valve replacement, while also providing a basis to differentiate the procedural hematologic impact between surgical and transcatheter approaches [ 6 – 8 ]. The objective of this study was to examine the incidence, severity, and temporal dynamics of thrombocytopenia in patients undergoing SAVR with a bioprosthesis or TAVI between 2017 and 2023. Uniquely, this investigation focused on the comparative impact of both procedures on platelet counts during the early postoperative period—specifically on postoperative days 1 and 2—an aspect that has been insufficiently addressed in the current literature. Methods Study Design and Ethics Approval This retrospective, single-center cohort study was conducted between January 2017 and December 2023. The study was approved by the Institutional Ethics Committee of Mersin City Education and Research Hospital (approval number: 78017789/050.01.04/2812868; decision no: 2024/741, dated 07/08/2024). Informed consent was waived due to the study's retrospective design. All procedures were performed in accordance with the principles of the Declaration of Helsinki. Study Population Consecutive adult patients (≥ 18 years) with severe symptomatic native aortic stenosis who underwent either transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) with a bioprosthetic valve were included. Severe aortic stenosis was defined echocardiographically as an aortic valve area ≤ 1.0 cm² (or indexed valve area ≤ 0.6 cm²/m²) and a mean transvalvular gradient > 40 mmHg or a peak aortic jet velocity ≥ 4.0 m/s. Among the 132 patients who underwent surgical bioprosthetic AVR, 114 cases were derived from a previously published doctoral thesis by Elbir (2018) conducted at the University of Health Sciences, Dr. Siyami Ersek Hospital, whereas the remaining 18 cases originated from the institutional cohort of Mersin City Education and Research Hospital. The doctoral thesis data were reanalyzed for the current study using a different research question and a comparative analytical design. Exclusion Criteria Patients were excluded if they underwent mechanical valve replacement, had active infective endocarditis, required redo cardiac surgery, experienced intraoperative death, underwent concomitant valve surgery other than SAVR with a bioprosthesis, or had incomplete perioperative platelet count data. Procedural Characteristics Treatment allocation (TAVI versus SAVR) was determined by a multidisciplinary heart team after comprehensive evaluation of patient comorbidities, anatomical suitability, and estimated surgical risk In the SAVR group, procedures were performed via median sternotomy or minimally invasive approaches under cardiopulmonary bypass (CPB), using stented, stentless, or sutureless bioprosthetic valves. In the TAVI group, most procedures were performed via transfemoral access, while transapical access was reserved for patients with unsuitable peripheral vascular anatomy. Both balloon-expandable and self-expanding transcatheter valve systems were used. Data Collection Baseline demographic, clinical, laboratory, and echocardiographic data were retrospectively obtained from institutional medical records. Procedural and echocardiographic variables included Society of Thoracic Surgeons (STS) score, EuroSCORE II, CPB, and aortic cross-clamp durations (for SAVR), as well as valve type, valve size, access route, and valve generation (for TAVI). Laboratory parameters included platelet counts measured at four predefined time points (preoperative, immediate postprocedural, postoperative day 1, and postoperative day 2), as well as hemoglobin, creatinine, C-reactive protein, and liver enzyme levels. Clinical outcomes assessed during hospitalization included bleeding events, transfusion requirements, acute kidney injury, stroke, vascular complications, intensive care unit (ICU) length of stay, hospital length of stay, and 30-day mortality. Study Endpoints The primary endpoint was postoperative thrombocytopenia, defined as a ≥ 50% reduction in platelet count from baseline to the postoperative nadir [ 1 – 3 ]. Secondary endpoints included absolute and relative changes in platelet counts, timing of the platelet nadir, recovery to ≥ 90% of baseline platelet levels, and associations between thrombocytopenia and early clinical outcomes. Statistical Analysis All statistical analyses were performed using IBM SPSS Statistics version 25.0 (IBM Corp., Armonk, NY, USA). Categorical variables are presented as frequencies and percentages, whereas continuous variables are expressed as means ± standard deviations. Comparisons between groups were conducted using the chi-square test for categorical variables; continuity correction was applied for 2×2 tables, and Fisher’s exact test was used when appropriate. Continuous variables were compared using the independent-samples t-test. Homogeneity of variances was assessed using Levene’s test, and Welch’s correction was applied when this assumption was violated. A two-tailed p-value < 0.05 was considered statistically significant. Perioperative changes in platelet counts were analyzed using repeated-measures general linear models (GLMs). Two separate models were constructed: (1) preoperative, immediate postprocedural, and postoperative day 1 platelet values; and (2) immediate postprocedural, postoperative day 1, and postoperative day 2 values. In both models, time (three measurement points) was treated as a within-subject factor, and treatment group (SAVR versus TAVI) as a between-subject factor. Mauchly’s test of sphericity was applied, and Greenhouse–Geisser corrections were used when sphericity was violated. Equality of covariance matrices across groups was assessed using Box’s M test. Linear and quadratic contrasts were additionally examined to explore trends across time points [ 9 ]. Results An evaluation of the demographic and clinical profiles of the study population revealed that patients in the TAVI cohort were significantly older than those in the surgical cohort (p < 0.001). In addition, the prevalence of diabetes mellitus and prior acute coronary syndrome was greater among TAVI patients (both p ≤ 0.001). Hemoglobin concentrations were greater in the surgical group (p = 0.031), whereas CRP levels were elevated in the TAVI group (p = 0.005). Further significant differences were observed in creatinine (p < 0.001) and ALT (p < 0.001) levels (Table 1 ). Table 1 Baseline Characteristics of Patients Undergoing Surgery vs. TAVI Variable Surgery (n = 132) TAVI (n = 116) p-value Age (years) 70.7 ± 4.9 78.3 ± 7.3 < 0.001 Female sex 65 (49.2%) 61 (52.6%) 0.599 Diabetes Mellitus 43 (32.6%) 74 (63.8%) < 0.001 Hypertension 121 (91.7%) 108 (93.1%) 0.671 History of ACS 43 (32.6%) 63 (54.3%) 0.001 COPD 23 (17.4%) 29 (25.0%) 0.144 Hemoglobin (g/dl) 14.15 ± 1.35 12.64 ± 7.87 0.031 WBC (10³/µL) 7.04 ± 2.38 7.46 ± 2.36 0.160 CRP (mg/dl) 0.60 ± 1.23 1.28 ± 2.44 0.005 ALT (U/L) 27.00 ± 12.32 18.32 ± 20.40 < 0.001 AST (U/L) 25.36 ± 8.12 24.93 ± 15.08 0.775 Albumin (g/dl) 4.06 ± 0.42 4.30 ± 1.61 0.093 Creatinine (mg/dl) 1.42 ± 0.31 1.06 ± 0.63 < 0.001 With respect to clinical and echocardiographic findings, TAVI patients presented higher surgical risk scores and more advanced symptomatic status than did those who underwent surgery (both p < 0.001). Although the left ventricular ejection fraction was comparable between the groups (p = 0.982), the surgical group had a smaller aortic valve area (p < 0.001) and greater pressure gradient (p ≤ 0.026) (Table 2 ). Table 2 Comparison of Echocardiographic and Clinical Variables Between Surgery and TAVI Groups Variable Surgery (n = 132) TAVI (n = 116) p-value STS score 5.85 ± 2.90 12.40 ± 6.63 < 0.001 NYHA 2.43 ± 0.50 2.97 ± 0.18 < 0.001 LVEF (%) 45.9 ± 10.6 45.9 ± 10.5 0.982 AVA (cm²) 0.80 ± 0.12 0.85 ± 0.07 < 0.001 Aortic annulus diameter (mm) 24.80 ± 2.27 24.55 ± 2.26 0.397 Max aortic gradient (mmHg) 80.1 ± 13.3 75.6 ± 16.8 0.020 Mean aortic gradient (mmHg) 55.1 ± 9.6 52.0 ± 12.1 0.026 The perioperative platelet count significantly decreased overall over time (p < 0.001). The trajectory of this decline varied between groups, with a highly significant time-by-group interaction (p < 0.001). In surgical patients, a pronounced intraoperative decline persisted on the first and second postoperative days. A downward trend was also observed in the TAVI group, but the decrease was less steep and more gradual. Between-group analysis revealed no baseline difference preoperatively (p = 0.599); however, significant disparities emerged during the intraoperative and postoperative phases (all p < 0.001). Within-group temporal comparisons confirmed significant changes between preoperative–intraoperative, preoperative-day 1, and intraoperative-day 1 measurements (each p < 0.001). The decline from postoperative day 1 to day 2 was smaller but remained statistically significant (p = 0.011) (Table 3 ). Table 3 Comparison of Platelet Counts Between Surgery and TAVI Groups (Repeated Measures) Time Point Surgery (Mean ± SD) TAVI (Mean ± SD) Between-Group p-value Preop vs Intraop (p) Intraop vs Day 1 (p) Preop vs Day 1 (p) Time*group interaction Preoperative 224.67 ± 64.33 229.84 ± 81.19 0.599 < 0.001 0.895 < 0.001 < 0.001 Intraoperative 134.55 ± 45.82 210.83 ± 78.54 < 0.001 Postoperative Day 1 113.09 ± 48.69 189.97 ± 75.81 < 0.001 Time Point Surgery (Mean ± SD) TAVI (Mean ± SD) Between-Group p-value Intraop vs Day 1 (p) Day 1 vs Day 2 (p) Intraop vs Day 2 (p) Time*group interaction Intraoperative 134.55 ± 45.82 210.83 ± 78.54 < 0.001 < 0.001 0.011 < 0.001 0.755 Postoperative Day 1 113.09 ± 48.69 189.97 ± 75.81 < 0.001 Postoperative Day 2 102.87 ± 60.86 184.34 ± 73.80 < 0.001 Graphical inspection confirmed these results: platelet counts decreased sharply and consistently in the surgical cohort, whereas the TAVI group displayed a flatter curve with a more moderate reduction (Fig. 1 ). Line graph showing the temporal changes in platelet counts measured preoperatively, intraoperatively, and on postoperative days 1 and 2 in patients undergoing surgical aortic valve replacement (SAVR) with a bioprosthetic valve versus transcatheter aortic valve implantation (TAVI). A marked intraoperative decline followed by a further reduction on postoperative days 1 and 2 is observed in the surgical cohort, whereas a more gradual and moderate decline is noted in the TAVI group. Error bars represent standard deviations. Statistical significance was observed for both within-group and between-group comparisons (p < 0.001). Discussion In this study, we observed that perioperative thrombocytopenia is almost universal following both SAVR with a bioprosthetic valve and TAVI, yet the pattern, depth, and clinical implications differ distinctly between the two modalities. In our cohort, surgical patients experienced a steep intraoperative decline that persisted until postoperative day 2, whereas TAVI patients demonstrated a more gradual and moderate decrease. Despite being older and having higher surgical risk scores, TAVI patients nonetheless had shorter hospital stays, underscoring the procedural and recovery advantages of the transcatheter approach. In accordance with Elbir's findings (2018), postoperative thrombocytopenia was significantly more frequent and profound in patients undergoing surgical AVR with bioprosthetic valves than in those receiving mechanical valves or CABG (p < 0.01) [ 10 ]. The thesis also demonstrated that platelet counts typically reached their nadir around postoperative day 2 and gradually normalized within the first week, without major bleeding or re-exploration. These data support our present results showing a transient, clinically significant decline in platelet count. Furthermore, Elbir emphasized that the cardiopulmonary bypass circuit and glutaraldehyde-treated bioprosthetic tissue might contribute to early platelet consumption through surface-mediated activation. Importantly, no significant association between platelet nadir and surgical bleeding or revision was found, reinforcing the interpretation that postoperative thrombocytopenia in this setting is self-limited rather than pathological. Several recent studies have confirmed that early postoperative thrombocytopenia—particularly evident on postoperative day 1—carries prognostic relevance following surgical bioprosthetic aortic valve replacement. In the multicenter PORTRAIT study, including 1,233 patients, platelet counts significantly declined by postoperative day 1 across all valve types, and patients with greater early reductions demonstrated higher rates of bleeding, longer ICU stays, and increased transfusion requirements, suggesting an adverse clinical impact of early platelet depletion [ 6 ]. Similarly, a 2024 comparative study evaluating sutureless versus conventional stented valves reported that the platelet count on postoperative day 1 was significantly lower in the sutureless group, and this early thrombocytopenia was independently associated with greater postoperative bleeding and prolonged hospitalization [ 7 ]. The authors proposed that surface characteristics and rapid deployment techniques may intensify blood–biomaterial interaction, enhancing platelet consumption during the initial postoperative period. Furthermore, data from a 2024 analysis in The Journal of Chest Surgery confirmed that patients with early (day 1) platelet nadirs had higher incidences of postoperative transfusion, re-exploration for bleeding, and in-hospital mortality than those with stable platelet counts [ 8 ]. Collectively, these studies underscore that postoperative day 1 thrombocytopenia is not merely a benign laboratory finding but rather an early marker of adverse outcomes in surgical bioprosthetic valve recipients, highlighting the importance of vigilant perioperative hematologic monitoring and individualized transfusion strategies. Li et al. (2023) developed a predictive model for severe thrombocytopenia (≈ 25%) after transfemoral TAVR, identifying risk factors such as weight < 60 kg, NYHA class IV, major vascular complications, and a lower first postprocedural platelet count (c-statistic ≈ 0.758) [ 3 ]. This work underscores that patient and procedural variables jointly modulate risk. In surgical AVR, D’Alonzo et al. (2024) compared Inspiris Resilia and Carpentier Magna Ease valves, and reported that Inspiris Resilia was associated with a lower incidence of moderate-to-severe thrombocytopenia, yet there were no significant differences in clinical outcomes such as bleeding or transfusion rates [ 5 ]. These findings suggest that valve material and preservation technique continue to influence platelet dynamics even in modern prostheses. Despite worse functional status and higher risk scores, TAVI patients in our cohort had shorter hospital stays—a finding consistent with the procedure's minimally invasive nature, reduced hemodynamic insult, and more rapid mobilization. This differential recovery dynamic may partially mitigate the impact of modest thrombocytopenia in the TAVI group. One of the novel contributions of our study is the explicit focus on the difference between postoperative day 1 and day 2 platelet counts. In our data, even though the decline from day 1 to day 2 was smaller than that from day 1 to day 2, it remained statistically significant (p = 0.011). This suggests continuing platelet consumption or failure to recover in the early postoperative period, particularly in surgical patients. Given that some registries (e.g., Olasińska-Wiśniewska) identify the nadir around days 2–3 [ 1 ], close monitoring of this transition phase may provide early prognostic signals or guide interventions (e.g., transfusions, antiplatelet adjustments). Recent works confirm that platelet decline after valve intervention remains a clinically relevant phenomenon. Olasińska-Wiśniewska et al. (2025) reported that the most pronounced platelet count drop (PCD) occurs on postoperative days 2–3, especially in patients receiving Perceval prostheses, with more than 90% of those patients experiencing a > 50% drop, although they reported no effect on 1-year survival [ 1 ]. That study also noted that newer bioprosthesis models tend to produce milder reductions. In a multicenter TAVI registry (n = 3,913), acquired thrombocytopenia (≥ 50% decline) occurred in 14.8% of patients, and was associated with increased 30-day mortality (8.5% vs 2.0%, adjusted OR ≈ 2.3), lower procedural safety, and higher 2-year mortality (HR ≈ 2.2) [ 2 , 11 , 12 ]. Notably, late nadir thrombocytopenia (≥ day 4) is associated with worse outcomes than early nadir thrombocytopenia [ 2 ]. These data emphasize that thrombocytopenia in TAVI patients is not always benign. The PORTRAIT multicenter observational trial (2011–2019) provided further evidence that postoperative platelet reduction varies across surgical bioprostheses and that CPB time, cross-clamp time, and valve size are independent factors influencing the magnitude of platelet decline [ 4 , 13 ]. These mechanistic and observational data provide a backdrop for interpreting our findings. The more profound drop in the SAVR group likely reflects multiple operative insults: CPB-related effects, including hemodilution from prime solution, shear stress activation, platelet–circuit interactions, and continued consumption. Heparin dose & reversal dynamics: Higher systemic anticoagulation doses and protamine neutralization may contribute to platelet dysfunction or destruction.Valve preservation residues: Incomplete rinsing of glutaraldehyde-preserved leaflets can release residual chemicals that injure platelets.Shear and flow: Recent modeling (e.g., Abbas & Borazjani, 2025) shows that shear-induced platelet activation and residence time differ across prosthetic valve designs; bioprosthetic valves, while lower in shear than mechanical valves, can still promote subtle platelet activation during flow transitions [ 14 ]. Device-specific properties: Modern surgical prostheses (e.g., Resilia, Inspiris) may mitigate platelet injury, as D’Alonzo et al. suggest [ 5 ]. While many TAVI-associated platelet declines are modest, the registry data highlight a non-negligible risk. The associations of thrombocytopenia with increased 30-day mortality and procedural complications merit attention [ 11 , 12 ]. Thus, even moderate declines should not be dismissed, especially in patients who cross a threshold of clinical sensitivity (e.g., elderly, CKD, preexisting bleeding risk). Our models identified procedural and patient-level factors associated with thrombocytopenia. These findings align with the predictive factors identified in recent TAVI studies [ 3 ]. For SAVR, the CPB and cross-clamp durations remain fundamental predictors (consistent with PORTRAIT [ 4 ]). Future refinements might integrate biomarker levels (e.g., d-dimer, TAT, vWF) or pre-op platelet function assays. A contemporary timeframe (2017–2023) captures modern prosthesis designs. The cohort includes both TAVI and surgical bioprosthesis arms from a single institution, thereby enhancing internal consistency. Detailed platelet trajectory measurement (baseline, intraop, POD1, POD2) enabled fine-grained kinetics assessment. Our findings extend the growing body of evidence by confirming that thrombocytopenia is almost universal after aortic valve interventions. However, its trajectory and clinical implications differ depending on the treatment modality [ 15 ]. The sharper, more sustained decline observed in surgical patients highlights the unique hematologic effects of cardiopulmonary bypass and prosthesis-related factors [ 16 ]. Importantly, the transition from postoperative day 1 to day 2 appears to be a critical period, particularly in SAVR patients, and deserves attention as a potential early prognostic marker [ 17 ]. This observation is consistent with recent studies showing that early postoperative platelet dynamics may predict adverse outcomes and should not be underestimated [ 18 ]. Finally, integrating modern valve designs with careful risk stratification may further optimize outcomes in patients undergoing valve therapy. Advances in device technology and perioperative care are expected to reduce the incidence and severity of thrombocytopenia, thereby improving both short- and long-term prognoses [ 19 ]. Perioperative thrombocytopenia remains a frequent finding after both SAVR and TAVI. The decline is sharper and more sustained in surgical patients, whereas TAVI is associated with a more moderate reduction, despite being performed in older, higher-risk individuals [ 13 ]. Close and early monitoring of platelet counts in the postoperative period is therefore essential for timely intervention and improved outcomes [ 14 , 15 ]. Future research should expand current evidence by conducting prospective multicenter studies that assess platelet kinetics beyond the early postoperative phase, particularly on days 5–7 and later, in combination with comprehensive biomarker panels. Randomized substudies comparing different valve types and heparinization protocols could further elucidate procedural determinants of platelet decline. Moreover, integrating validated thrombocytopenia risk scores across diverse patient populations may enhance preoperative risk stratification. Finally, interventional strategies—such as individualized transfusion thresholds or antiplatelet regimen adjustments guided by early postoperative platelet trends—may help mitigate complications and improve patient outcomes after both surgical and transcatheter valve procedures. Limitations The retrospective, observational nature of the study precludes causal inference. A single-center design may limit external validity. We lacked systematic testing for heparin-induced thrombocytopenia (HIT). Contrast nephropathy assessment was limited by the timing of sampling. No long-term platelet recovery assessment was performed beyond the early postoperative period. Sample-size-restricted power for rare outcomes. Conclusion Perioperative thrombocytopenia is a frequent and consistent finding after both surgical and transcatheter bioprosthetic aortic valve replacement. While SAVR is associated with a sharper and more sustained decline in platelet counts, TAVI results in a more moderate reduction, despite being performed in older, higher-risk patients. The early postoperative period, particularly the transition from day 1 to day 2, represents a critical phase for monitoring, as continued decreases may identify patients at increased risk. These findings emphasize the importance of vigilant perioperative surveillance and suggest that integrating procedural characteristics with patient risk profiles may help optimize outcomes in aortic valve therapy.. Abbreviations AVR Aortic valve replacement CPB Cardiopulmonary bypass POD Postoperative day SAVR Surgical aortic valve replacement TAVI Transcatheter aortic valve implantation Declarations Ethics approval and consent to participate This study was approved by the Institutional Ethics Committee of Mersin City Education and Research Hospital (approval number: 78017789/050.01.04/2812868; decision no: 2024/741, dated 07/08/2024). Informed consent was waived due to the study's retrospective design. Consent for publication Competing interests The authors declare that they have no competing interests. Authors’ information Not applicable. Funding The authors received no specific funding for this study. Author Contribution ÖK contributed to the study conception and design, data collection, statistical analysis, and manuscript drafting. MET, FE, and VK contributed to data acquisition and interpretation. KG contributed to the critical revision of the manuscript for important intellectual content. All authors read and approved the final manuscript. Acknowledgement The authors thank the staff of Mersin City Education and Research Hospital for their support during data collection. Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43:561–632. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease. J Am Coll Cardiol. 2021;77:e25–197. Li S, Zhang J, Wang Q, et al. Predictive model for severe thrombocytopenia after transfemoral TAVR. Front Cardiovasc Med. 2023;10:112233. Olasińska-Wiśniewska A, Pawlak A, Perek B, et al. Platelet count drop after Perceval prostheses. J Clin Med. 2025;14:222. D’Alonzo M, Rossi A, Ferrante G, et al. Thrombocytopenia after surgical AVR with Inspiris Resilia versus Magna Ease valves. J Card Surg. 2024;39:456–63. PORTRAIT Investigators. Platelet Reduction after Aortic Bioprosthesis Implantation: Results from the PORTRAIT Study. J Clin Med. 2023;12(23):7414. Hilker M, et al. Thrombocytopenia after sutureless and standard stented aortic valve replacement. J Card Surg. 2024;39(8):3127–38. Kim D, et al. Thrombocytopenia After Aortic Valve Replacement Using Perceval vs Conventional Bioprosthesis. J Chest Surg. 2024;57(2):134–43. Jiritano F, Lorusso R, Renzulli A, et al. Platelet reduction after TAVI: a multicenter analysis. Catheter Cardiovasc Interv. 2024;103:765–74. Elbir F. Aort kapak replasmanında biyoprotez kapak kullanımının postoperatif trombositopeni ile ilişkisi. Medical specialty thesis. University of Health Sciences, Dr. Siyami Ersek Hospital; 2018. McCabe JM, Huang PH, Krishnaswamy A, et al. Clinical implications of thrombocytopenia after TAVI. Circ Cardiovasc Interv. 2021;14:e009876. Tirado-Conte G, Rodés-Cabau J, Nombela-Franco L, et al. Prognostic impact of acquired thrombocytopenia after TAVI. Eur Heart J. 2025;46:987–96. PORTRAIT Investigators. Platelet reduction after surgical bioprostheses: a multicenter observational study. J Clin Med. 2023;12:1456. Abbas SS, Borazjani I. Shear-induced platelet activation in prosthetic valves. Ann Biomed Eng. 2025;53:112–24. Flaherty MP, Davidson CJ, Lim MJ, et al. Predictors and outcomes of thrombocytopenia after TAVR. Catheter Cardiovasc Interv. 2020;96:1123–31. Kaneko T, Vassileva CM, Chikwe J, et al. Surgical AVR versus TAVI in intermediate-risk patients. Ann Thorac Surg. 2021;112:1856–65. Saito Y, Watanabe H, Takahashi A, et al. Thrombocytopenia dynamics and bleeding risk after valve replacement. Heart Vessels. 2022;37:901–10. Rodriguez-Gabella T, Giustino G, Nombela-Franco L, et al. Prognostic impact of thrombocytopenia after TAVI. JACC Cardiovasc Interv. 2021;14:2022–34. Alkhouli M, Goel K, Sengupta PP, et al. Contemporary outcomes of TAVI with new-generation valves: hematologic complications. J Am Coll Cardiol. 2022;79:2345–56. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 16 Apr, 2026 Reviews received at journal 15 Apr, 2026 Reviews received at journal 11 Apr, 2026 Reviewers agreed at journal 11 Apr, 2026 Reviewers agreed at journal 10 Apr, 2026 Reviewers agreed at journal 09 Apr, 2026 Reviewers agreed at journal 09 Apr, 2026 Reviewers invited by journal 04 Feb, 2026 Editor assigned by journal 26 Dec, 2025 Submission checks completed at journal 26 Dec, 2025 First submitted to journal 21 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8418122","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":586527697,"identity":"2e3a6819-fb3e-41fb-acb1-e79475584c13","order_by":0,"name":"ÖZKAN KARACA","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYFCCBCA+wMDAD2YXkKJFsgHENiBFi8EBEIcYLbrtCYwPf5y5J298fnXihwcGDPL8YgfwazE784DZQOJGseG2G283SwAdZjhzdgIBLTcS2CQMPiQkmN04uwGkJcHgNjFaEoBajGec3fyDeC0HbiQkGPD3biPSljMPmw0bziQYzrjBu80iwUCCCL8cTz748MexBHn+/rObb/6osJHnlyaghYGBsQFCS4BVShBSjgz4D5CiehSMglEwCkYSAADdIkjKPbwfSQAAAABJRU5ErkJggg==","orcid":"","institution":"Mersin City Training and Research Hospital","correspondingAuthor":true,"prefix":"","firstName":"ÖZKAN","middleName":"","lastName":"KARACA","suffix":""},{"id":586527700,"identity":"4735ed8d-7774-40ae-9bb3-2fa0036ea21f","order_by":1,"name":"Mehmet Erin Tüysüz","email":"","orcid":"","institution":"Mersin City Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mehmet","middleName":"Erin","lastName":"Tüysüz","suffix":""},{"id":586527701,"identity":"2133a8b4-cd0e-42d8-b7fe-b579666561be","order_by":2,"name":"Ferruh Elbir","email":"","orcid":"","institution":"Mersin City Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ferruh","middleName":"","lastName":"Elbir","suffix":""},{"id":586527703,"identity":"8499a5da-c54d-43d7-a7a4-119828fa914f","order_by":3,"name":"Vehbi Kınay","email":"","orcid":"","institution":"Mersin City Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Vehbi","middleName":"","lastName":"Kınay","suffix":""},{"id":586527707,"identity":"11227a13-c6df-4ccd-a658-305df2f6813d","order_by":4,"name":"Kemal Göçer","email":"","orcid":"","institution":"HG Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kemal","middleName":"","lastName":"Göçer","suffix":""}],"badges":[],"createdAt":"2025-12-21 15:08:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8418122/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8418122/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102211879,"identity":"d56f1846-3d6f-4b0a-b7d2-0017b8e82856","added_by":"auto","created_at":"2026-02-09 12:30:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":77702,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePerioperative Platelet Count Trends in Surgical Bioprosthetic AVR and TAVI Groups.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8418122/v1/dd03079d80cb08c814cb252a.png"},{"id":102297345,"identity":"9fbd36b8-338b-4f49-b638-9a0b55117c1c","added_by":"auto","created_at":"2026-02-10 10:27:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":760307,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8418122/v1/b7932626-9c75-4cc1-ad24-2bc416d08aa0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perioperative Thrombocytopenia After Transcatheter Versus Surgical Bioprosthetic Aortic Valve Replacement: A Single-Center Retrospective Study","fulltext":[{"header":"Background","content":"\u003cp\u003eSevere aortic stenosis (AS) is one of the most common valvular heart diseases in elderly individuals and is associated with substantial morbidity and mortality when left untreated. SAVR with a bioprosthesis has long represented the standard therapy. In recent years, TAVI has emerged as a less invasive alternative, initially reserved for high-risk patients but increasingly adopted across the full spectrum of surgical risk categories [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHematological complications remain clinically relevant following valve replacement. Among these, thrombocytopenia is a well-recognized phenomenon after both SAVR and TAVI. The underlying mechanisms are multifactorial: in SAVR, platelet activation and consumption are linked to cardiopulmonary bypass (CPB), hemodilution, and systemic anticoagulation; in TAVI, factors such as shear stress, blood\u0026ndash;device interactions, and prosthesis-related effects may contribute [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Although often transient and asymptomatic, significant thrombocytopenia may predispose patients to bleeding events, transfusion requirements, or other adverse outcomes. Prior reports have produced inconsistent findings. Some studies indicate that SAVR patients, particularly those receiving stentless or sutureless valves such as the Freedom SOLO or Perceval, experience more profound platelet reductions [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Conversely, TAVI tends to cause a more gradual decline, although severe thrombocytopenia has been documented and, in some cases, is associated with worse outcomes [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Importantly, there is limited real-world evidence directly comparing these two strategies in the same institutional setting across contemporary practice years.\u003c/p\u003e \u003cp\u003eThe rationale for comparing preoperative and postoperative day 1 platelet counts in our study stems from recent evidence suggesting that early postoperative thrombocytopenia may serve as a prognostic indicator for bleeding complications, transfusion requirements, and even in-hospital mortality after surgical bioprosthetic aortic valve replacement, while also providing a basis to differentiate the procedural hematologic impact between surgical and transcatheter approaches [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe objective of this study was to examine the incidence, severity, and temporal dynamics of thrombocytopenia in patients undergoing SAVR with a bioprosthesis or TAVI between 2017 and 2023. Uniquely, this investigation focused on the comparative impact of both procedures on platelet counts during the early postoperative period\u0026mdash;specifically on postoperative days 1 and 2\u0026mdash;an aspect that has been insufficiently addressed in the current literature.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Ethics Approval\u003c/h2\u003e \u003cp\u003eThis retrospective, single-center cohort study was conducted between January 2017 and December 2023. The study was approved by the Institutional Ethics Committee of Mersin City Education and Research Hospital (approval number: 78017789/050.01.04/2812868; decision no: 2024/741, dated 07/08/2024). Informed consent was waived due to the study's retrospective design. All procedures were performed in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eConsecutive adult patients (\u0026ge;\u0026thinsp;18 years) with severe symptomatic native aortic stenosis who underwent either transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) with a bioprosthetic valve were included. Severe aortic stenosis was defined echocardiographically as an aortic valve area\u0026thinsp;\u0026le;\u0026thinsp;1.0 cm\u0026sup2; (or indexed valve area\u0026thinsp;\u0026le;\u0026thinsp;0.6 cm\u0026sup2;/m\u0026sup2;) and a mean transvalvular gradient\u0026thinsp;\u0026gt;\u0026thinsp;40 mmHg or a peak aortic jet velocity\u0026thinsp;\u0026ge;\u0026thinsp;4.0 m/s.\u003c/p\u003e \u003cp\u003eAmong the 132 patients who underwent surgical bioprosthetic AVR, 114 cases were derived from a previously published doctoral thesis by Elbir (2018) conducted at the University of Health Sciences, Dr. Siyami Ersek Hospital, whereas the remaining 18 cases originated from the institutional cohort of Mersin City Education and Research Hospital. The doctoral thesis data were reanalyzed for the current study using a different research question and a comparative analytical design.\u003c/p\u003e\n\u003ch3\u003eExclusion Criteria\u003c/h3\u003e\n\u003cp\u003ePatients were excluded if they underwent mechanical valve replacement, had active infective endocarditis, required redo cardiac surgery, experienced intraoperative death, underwent concomitant valve surgery other than SAVR with a bioprosthesis, or had incomplete perioperative platelet count data.\u003c/p\u003e\n\u003ch3\u003eProcedural Characteristics\u003c/h3\u003e\n\u003cp\u003eTreatment allocation (TAVI versus SAVR) was determined by a multidisciplinary heart team after comprehensive evaluation of patient comorbidities, anatomical suitability, and estimated surgical risk\u003c/p\u003e \u003cp\u003eIn the SAVR group, procedures were performed via median sternotomy or minimally invasive approaches under cardiopulmonary bypass (CPB), using stented, stentless, or sutureless bioprosthetic valves. In the TAVI group, most procedures were performed via transfemoral access, while transapical access was reserved for patients with unsuitable peripheral vascular anatomy. Both balloon-expandable and self-expanding transcatheter valve systems were used.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003e Baseline demographic, clinical, laboratory, and echocardiographic data were retrospectively obtained from institutional medical records. Procedural and echocardiographic variables included Society of Thoracic Surgeons (STS) score, EuroSCORE II, CPB, and aortic cross-clamp durations (for SAVR), as well as valve type, valve size, access route, and valve generation (for TAVI).\u003c/p\u003e \u003cp\u003eLaboratory parameters included platelet counts measured at four predefined time points (preoperative, immediate postprocedural, postoperative day 1, and postoperative day 2), as well as hemoglobin, creatinine, C-reactive protein, and liver enzyme levels. Clinical outcomes assessed during hospitalization included bleeding events, transfusion requirements, acute kidney injury, stroke, vascular complications, intensive care unit (ICU) length of stay, hospital length of stay, and 30-day mortality.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStudy Endpoints\u003c/h2\u003e \u003cp\u003eThe primary endpoint was postoperative thrombocytopenia, defined as a\u0026thinsp;\u0026ge;\u0026thinsp;50% reduction in platelet count from baseline to the postoperative nadir [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Secondary endpoints included absolute and relative changes in platelet counts, timing of the platelet nadir, recovery to \u0026ge;\u0026thinsp;90% of baseline platelet levels, and associations between thrombocytopenia and early clinical outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were performed using IBM SPSS Statistics version 25.0 (IBM Corp., Armonk, NY, USA). Categorical variables are presented as frequencies and percentages, whereas continuous variables are expressed as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations. Comparisons between groups were conducted using the chi-square test for categorical variables; continuity correction was applied for 2\u0026times;2 tables, and Fisher\u0026rsquo;s exact test was used when appropriate. Continuous variables were compared using the independent-samples t-test. Homogeneity of variances was assessed using Levene\u0026rsquo;s test, and Welch\u0026rsquo;s correction was applied when this assumption was violated. A two-tailed p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003cp\u003ePerioperative changes in platelet counts were analyzed using repeated-measures general linear models (GLMs). Two separate models were constructed: (1) preoperative, immediate postprocedural, and postoperative day 1 platelet values; and (2) immediate postprocedural, postoperative day 1, and postoperative day 2 values. In both models, time (three measurement points) was treated as a within-subject factor, and treatment group (SAVR versus TAVI) as a between-subject factor. Mauchly\u0026rsquo;s test of sphericity was applied, and Greenhouse\u0026ndash;Geisser corrections were used when sphericity was violated. Equality of covariance matrices across groups was assessed using Box\u0026rsquo;s M test. Linear and quadratic contrasts were additionally examined to explore trends across time points [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAn evaluation of the demographic and clinical profiles of the study population revealed that patients in the TAVI cohort were significantly older than those in the surgical cohort (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In addition, the prevalence of diabetes mellitus and prior acute coronary syndrome was greater among TAVI patients (both p\u0026thinsp;\u0026le;\u0026thinsp;0.001). Hemoglobin concentrations were greater in the surgical group (p\u0026thinsp;=\u0026thinsp;0.031), whereas CRP levels were elevated in the TAVI group (p\u0026thinsp;=\u0026thinsp;0.005). Further significant differences were observed in creatinine (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and ALT (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) levels (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristics of Patients Undergoing Surgery vs. TAVI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgery (n\u0026thinsp;=\u0026thinsp;132)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTAVI (n\u0026thinsp;=\u0026thinsp;116)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (49.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (52.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.599\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes Mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (32.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (63.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e121 (91.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108 (93.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.671\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of ACS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (32.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (54.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (17.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin (g/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.64\u0026thinsp;\u0026plusmn;\u0026thinsp;7.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC (10\u0026sup3;/\u0026micro;L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.04\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.46\u0026thinsp;\u0026plusmn;\u0026thinsp;2.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.28\u0026thinsp;\u0026plusmn;\u0026thinsp;2.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.00\u0026thinsp;\u0026plusmn;\u0026thinsp;12.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.32\u0026thinsp;\u0026plusmn;\u0026thinsp;20.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.36\u0026thinsp;\u0026plusmn;\u0026thinsp;8.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.93\u0026thinsp;\u0026plusmn;\u0026thinsp;15.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.775\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin (g/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWith respect to clinical and echocardiographic findings, TAVI patients presented higher surgical risk scores and more advanced symptomatic status than did those who underwent surgery (both p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Although the left ventricular ejection fraction was comparable between the groups (p\u0026thinsp;=\u0026thinsp;0.982), the surgical group had a smaller aortic valve area (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and greater pressure gradient (p\u0026thinsp;\u0026le;\u0026thinsp;0.026) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Echocardiographic and Clinical Variables Between Surgery and TAVI Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgery (n\u0026thinsp;=\u0026thinsp;132)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTAVI (n\u0026thinsp;=\u0026thinsp;116)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSTS score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.85\u0026thinsp;\u0026plusmn;\u0026thinsp;2.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e12.40\u0026thinsp;\u0026plusmn;\u0026thinsp;6.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNYHA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEF (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e45.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e45.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.982\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAVA (cm\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAortic annulus diameter (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e24.80\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e24.55\u0026thinsp;\u0026plusmn;\u0026thinsp;2.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.397\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMax aortic gradient (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e80.1\u0026thinsp;\u0026plusmn;\u0026thinsp;13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e75.6\u0026thinsp;\u0026plusmn;\u0026thinsp;16.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean aortic gradient (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e55.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e52.0\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe perioperative platelet count significantly decreased overall over time (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The trajectory of this decline varied between groups, with a highly significant time-by-group interaction (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In surgical patients, a pronounced intraoperative decline persisted on the first and second postoperative days. A downward trend was also observed in the TAVI group, but the decrease was less steep and more gradual. Between-group analysis revealed no baseline difference preoperatively (p\u0026thinsp;=\u0026thinsp;0.599); however, significant disparities emerged during the intraoperative and postoperative phases (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Within-group temporal comparisons confirmed significant changes between preoperative\u0026ndash;intraoperative, preoperative-day 1, and intraoperative-day 1 measurements (each p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The decline from postoperative day 1 to day 2 was smaller but remained statistically significant (p\u0026thinsp;=\u0026thinsp;0.011) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Platelet Counts Between Surgery and TAVI Groups (Repeated Measures)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime Point\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgery (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTAVI (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBetween-Group p-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePreop vs Intraop (p)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIntraop vs Day 1 (p)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePreop vs Day 1 (p)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTime*group interaction\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e224.67\u0026thinsp;\u0026plusmn;\u0026thinsp;64.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e229.84\u0026thinsp;\u0026plusmn;\u0026thinsp;81.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.599\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.895\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134.55\u0026thinsp;\u0026plusmn;\u0026thinsp;45.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e210.83\u0026thinsp;\u0026plusmn;\u0026thinsp;78.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative Day 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e113.09\u0026thinsp;\u0026plusmn;\u0026thinsp;48.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e189.97\u0026thinsp;\u0026plusmn;\u0026thinsp;75.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime Point\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgery (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTAVI (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBetween-Group p-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntraop vs Day 1 (p)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDay 1 vs Day 2 (p)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIntraop vs Day 2 (p)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTime*group interaction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134.55\u0026thinsp;\u0026plusmn;\u0026thinsp;45.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e210.83\u0026thinsp;\u0026plusmn;\u0026thinsp;78.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.755\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative Day 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e113.09\u0026thinsp;\u0026plusmn;\u0026thinsp;48.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e189.97\u0026thinsp;\u0026plusmn;\u0026thinsp;75.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative Day 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102.87\u0026thinsp;\u0026plusmn;\u0026thinsp;60.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e184.34\u0026thinsp;\u0026plusmn;\u0026thinsp;73.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eGraphical inspection confirmed these results: platelet counts decreased sharply and consistently in the surgical cohort, whereas the TAVI group displayed a flatter curve with a more moderate reduction (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eLine graph showing the temporal changes in platelet counts measured preoperatively, intraoperatively, and on postoperative days 1 and 2 in patients undergoing surgical aortic valve replacement (SAVR) with a bioprosthetic valve versus transcatheter aortic valve implantation (TAVI). A marked intraoperative decline followed by a further reduction on postoperative days 1 and 2 is observed in the surgical cohort, whereas a more gradual and moderate decline is noted in the TAVI group. Error bars represent standard deviations. Statistical significance was observed for both within-group and between-group comparisons (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we observed that perioperative thrombocytopenia is almost universal following both SAVR with a bioprosthetic valve and TAVI, yet the pattern, depth, and clinical implications differ distinctly between the two modalities. In our cohort, surgical patients experienced a steep intraoperative decline that persisted until postoperative day 2, whereas TAVI patients demonstrated a more gradual and moderate decrease. Despite being older and having higher surgical risk scores, TAVI patients nonetheless had shorter hospital stays, underscoring the procedural and recovery advantages of the transcatheter approach.\u003c/p\u003e \u003cp\u003eIn accordance with Elbir's findings (2018), postoperative thrombocytopenia was significantly more frequent and profound in patients undergoing surgical AVR with bioprosthetic valves than in those receiving mechanical valves or CABG (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The thesis also demonstrated that platelet counts typically reached their nadir around postoperative day 2 and gradually normalized within the first week, without major bleeding or re-exploration. These data support our present results showing a transient, clinically significant decline in platelet count. Furthermore, Elbir emphasized that the cardiopulmonary bypass circuit and glutaraldehyde-treated bioprosthetic tissue might contribute to early platelet consumption through surface-mediated activation. Importantly, no significant association between platelet nadir and surgical bleeding or revision was found, reinforcing the interpretation that postoperative thrombocytopenia in this setting is self-limited rather than pathological.\u003c/p\u003e \u003cp\u003eSeveral recent studies have confirmed that early postoperative thrombocytopenia\u0026mdash;particularly evident on postoperative day 1\u0026mdash;carries prognostic relevance following surgical bioprosthetic aortic valve replacement. In the multicenter PORTRAIT study, including 1,233 patients, platelet counts significantly declined by postoperative day 1 across all valve types, and patients with greater early reductions demonstrated higher rates of bleeding, longer ICU stays, and increased transfusion requirements, suggesting an adverse clinical impact of early platelet depletion [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSimilarly, a 2024 comparative study evaluating sutureless versus conventional stented valves reported that the platelet count on postoperative day 1 was significantly lower in the sutureless group, and this early thrombocytopenia was independently associated with greater postoperative bleeding and prolonged hospitalization [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The authors proposed that surface characteristics and rapid deployment techniques may intensify blood\u0026ndash;biomaterial interaction, enhancing platelet consumption during the initial postoperative period.\u003c/p\u003e \u003cp\u003eFurthermore, data from a 2024 analysis in The Journal of Chest Surgery confirmed that patients with early (day 1) platelet nadirs had higher incidences of postoperative transfusion, re-exploration for bleeding, and in-hospital mortality than those with stable platelet counts [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Collectively, these studies underscore that postoperative day 1 thrombocytopenia is not merely a benign laboratory finding but rather an early marker of adverse outcomes in surgical bioprosthetic valve recipients, highlighting the importance of vigilant perioperative hematologic monitoring and individualized transfusion strategies.\u003c/p\u003e \u003cp\u003eLi et al. (2023) developed a predictive model for severe thrombocytopenia (\u0026asymp;\u0026thinsp;25%) after transfemoral TAVR, identifying risk factors such as weight\u0026thinsp;\u0026lt;\u0026thinsp;60 kg, NYHA class IV, major vascular complications, and a lower first postprocedural platelet count (c-statistic\u0026thinsp;\u0026asymp;\u0026thinsp;0.758) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This work underscores that patient and procedural variables jointly modulate risk.\u003c/p\u003e \u003cp\u003eIn surgical AVR, D\u0026rsquo;Alonzo et al. (2024) compared Inspiris Resilia and Carpentier Magna Ease valves, and reported that Inspiris Resilia was associated with a lower incidence of moderate-to-severe thrombocytopenia, yet there were no significant differences in clinical outcomes such as bleeding or transfusion rates [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These findings suggest that valve material and preservation technique continue to influence platelet dynamics even in modern prostheses.\u003c/p\u003e \u003cp\u003eDespite worse functional status and higher risk scores, TAVI patients in our cohort had shorter hospital stays\u0026mdash;a finding consistent with the procedure's minimally invasive nature, reduced hemodynamic insult, and more rapid mobilization. This differential recovery dynamic may partially mitigate the impact of modest thrombocytopenia in the TAVI group.\u003c/p\u003e \u003cp\u003eOne of the novel contributions of our study is the explicit focus on the difference between postoperative day 1 and day 2 platelet counts. In our data, even though the decline from day 1 to day 2 was smaller than that from day 1 to day 2, it remained statistically significant (p\u0026thinsp;=\u0026thinsp;0.011). This suggests continuing platelet consumption or failure to recover in the early postoperative period, particularly in surgical patients. Given that some registries (e.g., Olasińska-Wiśniewska) identify the nadir around days 2\u0026ndash;3 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], close monitoring of this transition phase may provide early prognostic signals or guide interventions (e.g., transfusions, antiplatelet adjustments).\u003c/p\u003e \u003cp\u003eRecent works confirm that platelet decline after valve intervention remains a clinically relevant phenomenon. Olasińska-Wiśniewska et al. (2025) reported that the most pronounced platelet count drop (PCD) occurs on postoperative days 2\u0026ndash;3, especially in patients receiving Perceval prostheses, with more than 90% of those patients experiencing a\u0026thinsp;\u0026gt;\u0026thinsp;50% drop, although they reported no effect on 1-year survival [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. That study also noted that newer bioprosthesis models tend to produce milder reductions.\u003c/p\u003e \u003cp\u003eIn a multicenter TAVI registry (n\u0026thinsp;=\u0026thinsp;3,913), acquired thrombocytopenia (\u0026ge;\u0026thinsp;50% decline) occurred in 14.8% of patients, and was associated with increased 30-day mortality (8.5% vs 2.0%, adjusted OR\u0026thinsp;\u0026asymp;\u0026thinsp;2.3), lower procedural safety, and higher 2-year mortality (HR\u0026thinsp;\u0026asymp;\u0026thinsp;2.2) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Notably, late nadir thrombocytopenia (\u0026ge;\u0026thinsp;day 4) is associated with worse outcomes than early nadir thrombocytopenia [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These data emphasize that thrombocytopenia in TAVI patients is not always benign.\u003c/p\u003e \u003cp\u003eThe PORTRAIT multicenter observational trial (2011\u0026ndash;2019) provided further evidence that postoperative platelet reduction varies across surgical bioprostheses and that CPB time, cross-clamp time, and valve size are independent factors influencing the magnitude of platelet decline [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. These mechanistic and observational data provide a backdrop for interpreting our findings.\u003c/p\u003e \u003cp\u003eThe more profound drop in the SAVR group likely reflects multiple operative insults: CPB-related effects, including hemodilution from prime solution, shear stress activation, platelet\u0026ndash;circuit interactions, and continued consumption. Heparin dose \u0026amp; reversal dynamics: Higher systemic anticoagulation doses and protamine neutralization may contribute to platelet dysfunction or destruction.Valve preservation residues: Incomplete rinsing of glutaraldehyde-preserved leaflets can release residual chemicals that injure platelets.Shear and flow: Recent modeling (e.g., Abbas \u0026amp; Borazjani, 2025) shows that shear-induced platelet activation and residence time differ across prosthetic valve designs; bioprosthetic valves, while lower in shear than mechanical valves, can still promote subtle platelet activation during flow transitions [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Device-specific properties: Modern surgical prostheses (e.g., Resilia, Inspiris) may mitigate platelet injury, as D\u0026rsquo;Alonzo et al. suggest [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile many TAVI-associated platelet declines are modest, the registry data highlight a non-negligible risk. The associations of thrombocytopenia with increased 30-day mortality and procedural complications merit attention [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Thus, even moderate declines should not be dismissed, especially in patients who cross a threshold of clinical sensitivity (e.g., elderly, CKD, preexisting bleeding risk).\u003c/p\u003e \u003cp\u003eOur models identified procedural and patient-level factors associated with thrombocytopenia. These findings align with the predictive factors identified in recent TAVI studies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. For SAVR, the CPB and cross-clamp durations remain fundamental predictors (consistent with PORTRAIT [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]). Future refinements might integrate biomarker levels (e.g., d-dimer, TAT, vWF) or pre-op platelet function assays.\u003c/p\u003e \u003cp\u003eA contemporary timeframe (2017\u0026ndash;2023) captures modern prosthesis designs. The cohort includes both TAVI and surgical bioprosthesis arms from a single institution, thereby enhancing internal consistency. Detailed platelet trajectory measurement (baseline, intraop, POD1, POD2) enabled fine-grained kinetics assessment.\u003c/p\u003e \u003cp\u003eOur findings extend the growing body of evidence by confirming that thrombocytopenia is almost universal after aortic valve interventions. However, its trajectory and clinical implications differ depending on the treatment modality [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The sharper, more sustained decline observed in surgical patients highlights the unique hematologic effects of cardiopulmonary bypass and prosthesis-related factors [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Importantly, the transition from postoperative day 1 to day 2 appears to be a critical period, particularly in SAVR patients, and deserves attention as a potential early prognostic marker [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This observation is consistent with recent studies showing that early postoperative platelet dynamics may predict adverse outcomes and should not be underestimated [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Finally, integrating modern valve designs with careful risk stratification may further optimize outcomes in patients undergoing valve therapy. Advances in device technology and perioperative care are expected to reduce the incidence and severity of thrombocytopenia, thereby improving both short- and long-term prognoses [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Perioperative thrombocytopenia remains a frequent finding after both SAVR and TAVI. The decline is sharper and more sustained in surgical patients, whereas TAVI is associated with a more moderate reduction, despite being performed in older, higher-risk individuals [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Close and early monitoring of platelet counts in the postoperative period is therefore essential for timely intervention and improved outcomes [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFuture research should expand current evidence by conducting prospective multicenter studies that assess platelet kinetics beyond the early postoperative phase, particularly on days 5\u0026ndash;7 and later, in combination with comprehensive biomarker panels. Randomized substudies comparing different valve types and heparinization protocols could further elucidate procedural determinants of platelet decline. Moreover, integrating validated thrombocytopenia risk scores across diverse patient populations may enhance preoperative risk stratification. Finally, interventional strategies\u0026mdash;such as individualized transfusion thresholds or antiplatelet regimen adjustments guided by early postoperative platelet trends\u0026mdash;may help mitigate complications and improve patient outcomes after both surgical and transcatheter valve procedures.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThe retrospective, observational nature of the study precludes causal inference. A single-center design may limit external validity. We lacked systematic testing for heparin-induced thrombocytopenia (HIT). Contrast nephropathy assessment was limited by the timing of sampling. No long-term platelet recovery assessment was performed beyond the early postoperative period. Sample-size-restricted power for rare outcomes.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePerioperative thrombocytopenia is a frequent and consistent finding after both surgical and transcatheter bioprosthetic aortic valve replacement. While SAVR is associated with a sharper and more sustained decline in platelet counts, TAVI results in a more moderate reduction, despite being performed in older, higher-risk patients. The early postoperative period, particularly the transition from day 1 to day 2, represents a critical phase for monitoring, as continued decreases may identify patients at increased risk. These findings emphasize the importance of vigilant perioperative surveillance and suggest that integrating procedural characteristics with patient risk profiles may help optimize outcomes in aortic valve therapy..\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAVR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAortic valve replacement\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCPB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCardiopulmonary bypass\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePOD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePostoperative day\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSAVR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSurgical aortic valve replacement\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTAVI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTranscatheter aortic valve implantation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study was approved by the Institutional Ethics Committee of Mersin City Education and Research Hospital (approval number: 78017789/050.01.04/2812868; decision no: 2024/741, dated 07/08/2024). Informed consent was waived due to the study's retrospective design.\u003cb\u003eConsent for publication\u003c/b\u003e\u003c/p\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003ch2\u003eAuthors\u0026rsquo; information\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors received no specific funding for this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e\u0026Ouml;K contributed to the study conception and design, data collection, statistical analysis, and manuscript drafting. MET, FE, and VK contributed to data acquisition and interpretation. KG contributed to the critical revision of the manuscript for important intellectual content. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors thank the staff of Mersin City Education and Research Hospital for their support during data collection.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43:561\u0026ndash;632.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOtto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease. J Am Coll Cardiol. 2021;77:e25\u0026ndash;197.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi S, Zhang J, Wang Q, et al. Predictive model for severe thrombocytopenia after transfemoral TAVR. Front Cardiovasc Med. 2023;10:112233.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlasińska-Wiśniewska A, Pawlak A, Perek B, et al. Platelet count drop after Perceval prostheses. J Clin Med. 2025;14:222.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eD\u0026rsquo;Alonzo M, Rossi A, Ferrante G, et al. Thrombocytopenia after surgical AVR with Inspiris Resilia versus Magna Ease valves. J Card Surg. 2024;39:456\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePORTRAIT Investigators. Platelet Reduction after Aortic Bioprosthesis Implantation: Results from the PORTRAIT Study. J Clin Med. 2023;12(23):7414.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHilker M, et al. Thrombocytopenia after sutureless and standard stented aortic valve replacement. J Card Surg. 2024;39(8):3127\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim D, et al. Thrombocytopenia After Aortic Valve Replacement Using Perceval vs Conventional Bioprosthesis. J Chest Surg. 2024;57(2):134\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiritano F, Lorusso R, Renzulli A, et al. Platelet reduction after TAVI: a multicenter analysis. Catheter Cardiovasc Interv. 2024;103:765\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElbir F. Aort kapak replasmanında biyoprotez kapak kullanımının postoperatif trombositopeni ile ilişkisi. Medical specialty thesis. University of Health Sciences, Dr. Siyami Ersek Hospital; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcCabe JM, Huang PH, Krishnaswamy A, et al. Clinical implications of thrombocytopenia after TAVI. Circ Cardiovasc Interv. 2021;14:e009876.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTirado-Conte G, Rod\u0026eacute;s-Cabau J, Nombela-Franco L, et al. Prognostic impact of acquired thrombocytopenia after TAVI. Eur Heart J. 2025;46:987\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePORTRAIT Investigators. Platelet reduction after surgical bioprostheses: a multicenter observational study. J Clin Med. 2023;12:1456.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbbas SS, Borazjani I. Shear-induced platelet activation in prosthetic valves. Ann Biomed Eng. 2025;53:112\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlaherty MP, Davidson CJ, Lim MJ, et al. Predictors and outcomes of thrombocytopenia after TAVR. Catheter Cardiovasc Interv. 2020;96:1123\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaneko T, Vassileva CM, Chikwe J, et al. Surgical AVR versus TAVI in intermediate-risk patients. Ann Thorac Surg. 2021;112:1856\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaito Y, Watanabe H, Takahashi A, et al. Thrombocytopenia dynamics and bleeding risk after valve replacement. Heart Vessels. 2022;37:901\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRodriguez-Gabella T, Giustino G, Nombela-Franco L, et al. Prognostic impact of thrombocytopenia after TAVI. JACC Cardiovasc Interv. 2021;14:2022\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlkhouli M, Goel K, Sengupta PP, et al. Contemporary outcomes of TAVI with new-generation valves: hematologic complications. J Am Coll Cardiol. 2022;79:2345\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Thrombocytopenia, Surgical aortic valve replacement, Transcatheter aortic valve implantation, Bioprosthetic valve, Platelet dynamics","lastPublishedDoi":"10.21203/rs.3.rs-8418122/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8418122/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePostoperative 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eConsecutive 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, immediately after the procedure, and on postoperative days (PODs) 1 and 2. The primary endpoint was a\u0026thinsp;\u0026ge;\u0026thinsp;50% reduction in platelet count relative to baseline.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 248 patients were included (SAVR, n\u0026thinsp;=\u0026thinsp;132; TAVI, n\u0026thinsp;=\u0026thinsp;116). Patients undergoing TAVI were significantly older and had higher surgical risk scores, whereas hospital stay was shorter compared with the SAVR group. 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.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThrombocytopenia 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 help optimize clinical management.\u003c/p\u003e","manuscriptTitle":"Perioperative Thrombocytopenia After Transcatheter Versus Surgical Bioprosthetic Aortic Valve Replacement: A Single-Center Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 12:30:54","doi":"10.21203/rs.3.rs-8418122/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-16T10:21:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-15T10:48:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-11T13:17:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"7865875788202899456349649134712040584","date":"2026-04-11T11:57:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311119271981851301169072692930274494112","date":"2026-04-10T08:36:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"223553997680172762885862217821482878301","date":"2026-04-09T04:54:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"293107142480861759652085367728122693857","date":"2026-04-09T04:06:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-04T11:35:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-26T05:47:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-26T05:44:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2025-12-21T14:55:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"217ad7f3-985b-4a03-b858-5d7b802a50e6","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-19T09:38:56+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-09 12:30:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8418122","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8418122","identity":"rs-8418122","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}