von Willebrand Factor and Management of Heart Valve Disease: JACC Review Topic of the Week

J Am Coll Cardiol. 2019 Mar 12;73(9):1078-1088. doi: 10.1016/j.jacc.2018.12.045.


For decades, numerous observations have shown an intimate relationship between von Willebrand factor (VWF) multimer profile and heart valve diseases (HVD). The current knowledge of the unique biophysical properties of VWF helps us to understand the longstanding observations concerning the bleeding complications in patients with severe HVD. Not only does the analysis of the VWF multimer profile provide an excellent evaluation of HVD severity, it is also a strong predictor of clinical events. Also of importance, VWF responds within minutes to any significant change in hemodynamic valve status, making it an accurate marker of the quality of surgical and transcatheter therapeutic interventions. The authors provide in this review a practical, comprehensive, and evidence-based framework of the concept of VWF as a biomarker in HVD, advocating for its implementation into the clinical decision-making process besides usual clinical and imaging evaluation. They also delineate critical knowledge gaps and research priorities to definitely validate this concept.

Keywords: aortic stenosis; biomarker; bioprosthesis heart valve disease; mitral regurgitation; paravalvular regurgitation; point-of-care test; transcatheter aortic valve replacement; von Willebrand factor.

Publication types

  • Review

MeSH terms

  • Biomarkers / blood
  • Clinical Decision-Making*
  • Disease Management*
  • Heart Valve Diseases / blood*
  • Heart Valve Diseases / surgery
  • Heart Valve Prosthesis Implantation / methods*
  • Humans
  • Severity of Illness Index
  • von Willebrand Factor / metabolism*


  • Biomarkers
  • von Willebrand Factor