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Platelets: Implications in Aortic Valve Stenosis and Bioprosthetic Valve Dysfunction From Pathophysiology to Clinical

Stephanie L Sellers1,2,3, Gaurav S Gulsin1,2, Devyn Zaminski4

  • 1Department of Radiology, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.

JACC. Basic to Translational Science
|January 13, 2022
PubMed

Insights

Platelets significantly contribute to aortic stenosis (AS) and bioprosthetic valve dysfunction. Further research is needed to explore antiplatelet therapies for improving outcomes in AS patients.

Area of Science:

  • Cardiovascular Medicine
  • Hematology
  • Biomaterials Science

Background:

  • Aortic stenosis (AS) is a prevalent valvular heart disease, increasing with aging populations.
  • Calcific degeneration drives AS, with emerging evidence implicating platelets in its pathophysiology.
  • Platelets also contribute to bioprosthetic valve dysfunction through leaflet thrombosis and thickening.

Purpose of the Study:

  • To review the molecular functions of platelets in native and bioprosthetic aortic valve disease.
  • To discuss the impact of antiplatelet and anticoagulation therapies on aortic valve health.
  • To identify research gaps concerning platelet roles and therapeutic interventions in AS.

Main Methods:

  • Literature review focusing on platelet function in aortic valve disease.
  • Analysis of studies on platelet involvement in native valve calcification and bioprosthetic valve degeneration.
  • Synthesis of data on antiplatelet and anticoagulation therapies in aortic valve settings.

Main Results:

  • Platelets are key mediators in the molecular mechanisms of AS and bioprosthetic valve dysfunction.
  • Subclinical leaflet thrombosis is a concern for long-term durability of bioprosthetic valves.
  • The role of antiplatelet and anticoagulation therapies in AS requires further investigation.

Conclusions:

  • Understanding platelet biology is crucial for developing novel therapeutic strategies for AS.
  • Further studies are essential to determine the efficacy of antiplatelet and anticoagulation therapies in extending the lifespan of aortic valve implants.
  • Bridging basic science insights with clinical applications can lead to improved patient outcomes in aortic stenosis.

Keywords:
AS, aortic stenosisAV, aortic valveAVR, aortic valve replacementsCOX, cyclooxygenaseECM, extracellular matrix proteinHALT, hypoattenuating leaflet thickeningHMW, high molecular weightMK, megakaryocyteSAVR, surgical aortic valve replacementTAVRTAVR, transcatheter aortic valve replacementsTGF, transforming growth factorVEC, vascular endothelial cellVHD, valvular heart diseaseVIC, valve interstitial cellWSS, wall shear stressaortic stenosiscalcified aortic valvesplateletsthrombosisvWF, Von Willebrand factor

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