Treatment of acquired von Willebrand syndrome in aortic stenosis with transcatheter aortic valve replacement

Tobias Spangenberg; Ulrich Budde; Dimitry Schewel; Christian Frerker; Thomas Thielsen; Karl-Heinz Kuck; Ulrich Schäfer

doi:10.1016/j.jcin.2015.02.008

Treatment of acquired von Willebrand syndrome in aortic stenosis with transcatheter aortic valve replacement

JACC Cardiovasc Interv. 2015 Apr 27;8(5):692-700. doi: 10.1016/j.jcin.2015.02.008.

Authors

Tobias Spangenberg¹, Ulrich Budde², Dimitry Schewel³, Christian Frerker³, Thomas Thielsen³, Karl-Heinz Kuck³, Ulrich Schäfer⁴

Affiliations

¹ Division of Cardiology, Asklepios Klinik St. Georg Hospital, Hamburg, Germany. Electronic address: t.spangenberg@asklepios.com.
² Medilys Laborgesellschaft mbH, Hemostaseology, Hamburg, Germany.
³ Division of Cardiology, Asklepios Klinik St. Georg Hospital, Hamburg, Germany.
⁴ Division of Cardiology, Asklepios Klinik St. Georg Hospital, Hamburg, Germany; Division of Cardiology, University Heart Center Eppendorf, Hamburg, Germany.

PMID: 25946442
DOI: 10.1016/j.jcin.2015.02.008

Abstract

Objectives: This study sought to investigate the prevalence of abnormal von Willebrand multimers (AbM) in patients undergoing transcatheter aortic valve replacement (TAVR) and the impact of TAVR on the underlying factor variances.

Background: An association between the acquired von Willebrand syndrome (aVWS) and valvular aortic stenosis (AS) has been established in the past and surgical aortic valve replacement (SAVR) shown to lead to factor recovery. Prevalence and course of AbM in patients treated with TAVR though has not yet been described comprehensively.

Methods: Ninety-five consecutive patients underwent TAVR at our institution. Hemostaseologic testing was performed before and up to 1 week after TAVR. Transvalvular and right heart hemodynamics as well as bleeding episodes were recorded and analyzed with descriptive statistics.

Results: Baseline prevalence of AbM was 42% with an average high-molecular-weight multimer (HMWM) count of 16.2 ± 3.3%. Pressure gradients correlated significantly with the extent of HMWM deficiency (r = -0.63 [p < 0.0001]). Following valve implantation, HMWM increased proportional to the drop in mean pressure gradient and normalized in most of the patients. However, residual aortic regurgitation/leakage led to inferior HMWM recovery but prosthesis-patient mismatch (PPM) was rare and left HMWM uninfluenced. We saw no association of transfusion with AbM and 1-year mortality was unaffected by AbM.

Conclusions: AbM in patients with AS undergoing TAVR is frequent. However, TAVR is capable of correcting AbM and therefore possibly aVWS in patients with AS. As opposed to SAVR, bleeding and transfusion requirement in TAVR patients was not associated with severe HMWM deficiency; PPM was rare and HMWM were uninfluenced by the procedure. Aortic regurgitation after TAVR adversely influenced HMWM recovery.

Keywords: aortic stenosis; transcatheter aortic valve replacement; von Willebrand syndrome.

MeSH terms

Aged
Aged, 80 and over
Aortic Valve Insufficiency / diagnosis
Aortic Valve Insufficiency / epidemiology
Aortic Valve Stenosis / diagnosis
Aortic Valve Stenosis / epidemiology
Aortic Valve Stenosis / physiopathology
Aortic Valve Stenosis / therapy*
Cardiac Catheterization / adverse effects
Cardiac Catheterization / instrumentation
Cardiac Catheterization / methods*
Female
Germany / epidemiology
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation / adverse effects
Heart Valve Prosthesis Implantation / instrumentation
Heart Valve Prosthesis Implantation / methods*
Hemodynamics
Humans
Male
Prevalence
Registries
Risk Factors
Time Factors
Treatment Outcome
von Willebrand Diseases / blood
von Willebrand Diseases / diagnosis
von Willebrand Diseases / epidemiology
von Willebrand Diseases / therapy*