title: Immediate recovery of acquired von Willebrand syndrome after left ventricular assist device explantation: implications for heart transplantation.
abstract: All patients supported with continuous flow-left ventricular assist devices (CF-LVADs) develop acquired von Willebrand syndrome due to the loss of von Willebrand factor (vWF) high molecular weight (HMW) multimers and this phenomenon has been associated with clinical manifestation of bleeding diatheses. The precise timing of postoperative recovery of HMW multimers and correction of this condition after CF-LVAD explantation and heart transplantation is unknown. We sought to determine the specific timing of HMW multimer recovery by serially quantifying plasma vWF multimer ratios after CF-LVAD explant and orthotopic heart transplantation (OHT) in a patient implanted with a HeartWare ventricular assist device. Using densitometric analysis of multimer patterns, we demonstrated complete recovery of HMW multimers within the first few hours following CF-LVAD explant and OHT. These findings have critical implications in the context of perioperative bleeding diatheses in patients bridged to transplantation with a CF-LVAD.
authors.affiliation: From the *Department of Cardiac Surgery, †Division of Cardiovascular Medicine, and ‡Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Davis
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Haglund
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Tricarico
authors.forename: Anton
authors.initials: A
authors.lastname: Matafonov
authors.forename: David
authors.initials: D
authors.lastname: Gailani
authors.forename: Simon
authors.initials: S
authors.lastname: Maltais
mesh_terms: D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008970:Molecular Weight; D064547:Myxovirus Resistance Proteins; D019106:Postoperative Hemorrhage / Q000097:blood / Q000209:etiology; D012770:Shock, Cardiogenic / Q000601:surgery; D014842:von Willebrand Diseases / Q000097:blood / Q000209:etiology*; D014841:von Willebrand Factor / Q000737:chemistry / Q000378:metabolism
chemical_list: D064547:Myxovirus Resistance Proteins; D014841:von Willebrand Factor