Author + information
- Received December 8, 2014
- Revision received February 2, 2015
- Accepted February 27, 2015
- Published online April 27, 2015.
- Tobias Spangenberg, MD∗∗ (, )
- Ulrich Budde, MD†,
- Dimitry Schewel, MD∗,
- Christian Frerker, MD∗,
- Thomas Thielsen, MD∗,
- Karl-Heinz Kuck, MD∗ and
- Ulrich Schäfer, MD∗,‡
- ∗Division of Cardiology, Asklepios Klinik St. Georg Hospital, Hamburg, Germany
- †Medilys Laborgesellschaft mbH, Hemostaseology, Hamburg, Germany
- ‡Division of Cardiology, University Heart Center Eppendorf, Hamburg, Germany
- ↵∗Reprint requests and correspondence:
Dr. Tobias Spangenberg, Asklepios Klinik St. Georg, Department of Cardiology, Lohmuehlenstrasse 5, 20099 Hamburg, Germany.
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.
Dr. Kuck has served as a consultant for St. Jude Medical, Abbott Vascular, and Medtronic. Dr. Schäfer has served as a proctor for Medtronic, Edwards Lifesciences, and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 8, 2014.
- Revision received February 2, 2015.
- Accepted February 27, 2015.
- American College of Cardiology Foundation