Acquired von Willebrand syndrome associated with left ventricular assist device
- PMID: 27143258
- PMCID: PMC4920020
- DOI: 10.1182/blood-2015-10-636480
Acquired von Willebrand syndrome associated with left ventricular assist device
Abstract
Left ventricular assist devices (LVAD) provide cardiac support for patients with end-stage heart disease as either bridge or destination therapy, and have significantly improved the survival of these patients. Whereas earlier models were designed to mimic the human heart by producing a pulsatile flow in parallel with the patient's heart, newer devices, which are smaller and more durable, provide continuous blood flow along an axial path using an internal rotor in the blood. However, device-related hemostatic complications remain common and have negatively affected patients' recovery and quality of life. In most patients, the von Willebrand factor (VWF) rapidly loses large multimers and binds poorly to platelets and subendothelial collagen upon LVAD implantation, leading to the term acquired von Willebrand syndrome (AVWS). These changes in VWF structure and adhesive activity recover quickly upon LVAD explantation and are not observed in patients with heart transplant. The VWF defects are believed to be caused by excessive cleavage of large VWF multimers by the metalloprotease ADAMTS-13 in an LVAD-driven circulation. However, evidence that this mechanism could be the primary cause for the loss of large VWF multimers and LVAD-associated bleeding remains circumstantial. This review discusses changes in VWF reactivity found in patients on LVAD support. It specifically focuses on impacts of LVAD-related mechanical stress on VWF structural stability and adhesive reactivity in exploring multiple causes of AVWS and LVAD-associated hemostatic complications.
© 2016 by The American Society of Hematology.
Figures
Similar articles
-
Detection of acquired von Willebrand syndrome after ventricular assist device by total thrombus-formation analysis system.ESC Heart Fail. 2020 Oct;7(5):3235-3239. doi: 10.1002/ehf2.12824. Epub 2020 Jul 23. ESC Heart Fail. 2020. PMID: 32700467 Free PMC article.
-
Acquired von Willebrand syndrome in patients with a centrifugal or axial continuous flow left ventricular assist device.JACC Heart Fail. 2014 Apr;2(2):141-5. doi: 10.1016/j.jchf.2013.10.008. JACC Heart Fail. 2014. PMID: 24720921
-
Acquired von Willebrand syndrome in patients with an axial flow left ventricular assist device.Circ Heart Fail. 2010 Nov;3(6):675-81. doi: 10.1161/CIRCHEARTFAILURE.109.877597. Epub 2010 Aug 25. Circ Heart Fail. 2010. PMID: 20739614
-
Acquired von Willebrand syndrome in a child following Berlin Heart EXCOR Pediatric Ventricular Assist Device implantation: case report and concise literature review.World J Pediatr Congenit Heart Surg. 2014 Oct;5(4):592-8. doi: 10.1177/2150135114539521. World J Pediatr Congenit Heart Surg. 2014. PMID: 25324261 Review.
-
von Willebrand factor disruption and continuous-flow circulatory devices.J Heart Lung Transplant. 2017 Nov;36(11):1155-1163. doi: 10.1016/j.healun.2017.06.004. Epub 2017 Jun 12. J Heart Lung Transplant. 2017. PMID: 28756118 Review.
Cited by
-
Shear-Sensing by C-Reactive Protein: Linking Aortic Stenosis and Inflammation.Circ Res. 2024 Nov 8;135(11):1033-1047. doi: 10.1161/CIRCRESAHA.124.324248. Epub 2024 Oct 18. Circ Res. 2024. PMID: 39421928 Free PMC article.
-
The dynamics of red blood cells traversing slits of mechanical heart valves under high shear.Biophys J. 2024 Nov 5;123(21):3780-3797. doi: 10.1016/j.bpj.2024.09.027. Epub 2024 Sep 26. Biophys J. 2024. PMID: 39340153
-
Efficacy of venoarterial extracorporeal membrane oxygenation with and without intra-aortic balloon pump in adult cardiogenic shock.Front Cardiovasc Med. 2024 Sep 6;11:1431875. doi: 10.3389/fcvm.2024.1431875. eCollection 2024. Front Cardiovasc Med. 2024. PMID: 39309601 Free PMC article.
-
Shear Histories Alter Local Shear Effects on Thrombus Nucleation and Growth.Ann Biomed Eng. 2024 Apr;52(4):1039-1050. doi: 10.1007/s10439-023-03439-z. Epub 2024 Feb 6. Ann Biomed Eng. 2024. PMID: 38319505
-
Hemocompatibility and biophysical interface of left ventricular assist devices and total artificial hearts.Blood. 2024 Feb 22;143(8):661-672. doi: 10.1182/blood.2022018096. Blood. 2024. PMID: 37890145 Review.
References
-
- Cooley DA, Liotta D, Hallman GL, Bloodwell RD, Leachman RD, Milam JD. Orthotopic cardiac prosthesis for two-staged cardiac replacement. Am J Cardiol. 1969;24(5):723–730. - PubMed
-
- Frazier OH, Wampler RK, Duncan JM, et al. First human use of the Hemopump, a catheter-mounted ventricular assist device. Ann Thorac Surg. 1990;49(2):299–304. - PubMed
-
- Frazier OH. First use of an untethered, vented electric left ventricular assist device for long-term support. Circulation. 1994;89(6):2908–2914. - PubMed
-
- Frazier OH, Gregoric ID, Delgado RM, et al. Initial experience with the Jarvik 2000 left ventricular assist system as a bridge to transplantation: report of 4 cases. J Heart Lung Transplant. 2001;20(2):201. - PubMed
Publication types
MeSH terms
Substances
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Miscellaneous
