title: Correction of acquired von Willebrand syndrome by transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Acquired von Willebrand syndrome (aVWS) is a common complication of severe aortic valve stenosis and can be corrected by surgical valve replacement. Transcatheter aortic valve implantation (TAVI) is gaining importance, but the influence of this new technique on aVWS has never been examined. The objective of this study was to assess the impact of TAVI on aVWS.
  
  
  METHODS
  We enrolled 15 patients with severe aortic stenosis and high surgical risk admitted for elective TAVI. All patients were successfully treated by TAVI, using either the transfemoral (n = 6) or transapical approach (n = 9). Patients were screened for aVWS by measuring PFA-100 in vitro closure time, von Willebrand factor (VWF) antigen, VWF function, and VWF multimer analysis. Analyses were then repeated 30 minutes, 24 hours, and 7 days after valve replacement.
  
  
  RESULTS
  Fourteen of 15 patients showed pathologic alterations of VWF. An inverse correlation was observed between the transvalvular pressure gradient and VWF high-molecular-weight multimers (VWF:HMWM) (r = -0.621; P=.01), which are essential for the platelet dependent hemostatic function of VWF. Transaortic gradient was significantly reduced in all patients following TAVI. Hemostaseologic findings improved in all patients following TAVI, the percentage of VWF:HMWM increased (19.05 ± 5.19% before TAVI to 24.08 ± 4.75% (P=.04) on day 7 post TAVI), and the multimer pattern normalized.
  
  
  CONCLUSIONS
  Acquired von Willebrand syndrome due to aortic valve stenosis can successfully be corrected by TAVI.
authors.affiliation: Abteilung für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Martinistr. 52 20246 Hamburg, Germany. o.marggraf@gmx.de.
authors.forename: Olivier
authors.initials: O
authors.lastname: Marggraf
authors.forename: Sonja
authors.initials: S
authors.lastname: Schneppenheim
authors.forename: Anne
authors.initials: A
authors.lastname: Daubmann
authors.forename: Ulrich
authors.initials: U
authors.lastname: Budde
authors.forename: Moritz
authors.initials: M
authors.lastname: Seiffert
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
authors.forename: Hendrik
authors.initials: H
authors.lastname: Treede
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.forename: Patrick
authors.initials: P
authors.lastname: Diemert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000097:blood / Q000150:complications* / Q000601:surgery*; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006487:Hemostasis / Q000502:physiology; D006801:Humans; D008297:Male; D065467:Transcatheter Aortic Valve Replacement; D014842:von Willebrand Diseases / Q000097:blood / Q000601:surgery*; D014841:von Willebrand Factor / Q000032:analysis
chemical_list: D014841:von Willebrand Factor