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- Title
Changes in Von Willebrand factor profile predicts clinical outcomes in patients on mechanical circulatory support.
- Authors
Oezpeker, Cenk; Zittermann, Armin; Baurichter, Daniela; Morshuis, Michel; Prohaska, Wolfgang; Kassner, Astrid; Erkilet, Gülsüm; Gummert, Jan; Milting, Hendrik
- Abstract
<bold>Background: </bold>The associations between mechanical circulatory support (MCS), acquired von Willebrand syndrome (AvWS), and clinical outcome are incompletely understood.<bold>Methods: </bold>In 128 heart failure patients with pulsatile MCS implants (65 total artificial heart or biventricular assist device implants, 63 left ventricular assist device [LVAD] implants) and 76 patients with continuous flow LVAD implants, we analyzed the von Willebrand factor (vWF) profile before (≤24 h) and 17.5 (standard deviation: 5.1) days after device implant. We determined vWF concentrations, vWF activity, and vWF collagen binding capacity and calculated ratios of vWF activity/binding capacity with vWF concentration. The relation of the vWF profile with clinical outcomes such as stroke, gastrointestinal bleeding, and survival was also evaluated. Events were assessed up to 1 year of device implant.<bold>Results: </bold>All entities of vWF were already significantly elevated preoperatively and remained high after MCS implantation. The ratios of vWF activity/concentration (vWF:RCo/Ag) and collagen binding capacity/concentration (vWF:CBA/Ag) were significantly reduced preoperatively and remained low postoperatively, indicating AvWS. The preoperative alterations in the vWF profile were already present in patients without intra-aortic balloon pump and/or extracorporeal circulatory membrane oxygenation implants. The vWF profile was unrelated to postoperative stroke. However, a higher postoperative ratio of vWF:CBA/Ag was independently associated with increased gastrointestinal bleeding. In addition, a postoperative increase in vWF concentrations and activity were independent predictors of increased 1-year mortality.<bold>Conclusions: </bold>Our data indicate that AvWS is present in heart failure patients before device implantation, and is independently associated with clinical outcomes, especially with 1-year mortality.
- Subjects
VON Willebrand factor; HEART assist devices; HEART failure; BLOOD coagulation factors; ARTIFICIAL hearts
- Publication
Journal of Cardiac Surgery, 2018, Vol 33, Issue 10, p693
- ISSN
0886-0440
- Publication type
journal article
- DOI
10.1111/jocs.13794