Effects of transcutaneous aortic valve implantation on aortic valve disease-related hemostatic disorders involving von Willebrand factor.
BACKGROUND
Aortic valve stenosis (AVS) can be complicated by bleeding associated with acquired type 2A von Willebrand syndrome. The association of AVS and gastrointestinal bleeding from angiodysplasia is defined as Heyde syndrome. We sought to evaluate the effect of transcutaneous aortic valve implantation (TAVI) on hemostasis disorders and to assess its effectiveness to treat Heyde syndrome.


METHODS
We prospectively enrolled 49 consecutive patients with severe AVS addressed for TAVI at our institution. Biological hemostasis parameters involving von Willebrand factor (vWF) were assessed at baseline and 1 week after the procedure.


RESULTS
At baseline, a significant link between vWF abnormalities and the severity of AVS was evidenced: mean aortic transvalvular gradient was negatively correlated with the levels of vWF antigen (vWF:Ag) (r = -0.29; P < 0.05), vWF ristocetin cofactor activity (r = -0.402; P = 0.006), and vWF collagen-binding activity (vWF:CB; r = -0.441; P = 0.005). One week after the procedure, a significant increase of vWF:Ag, vWF ristocetin cofactor activity, and vWF:CB was evidenced in the whole cohort (respectively, 3.32 vs. 2.29 IU/mL, P < 0.001; 2.98 vs. 1.86 IU/mL, P < 0.001; and 3.16 vs. 2.16 IU/mL, P < 0.001). Patients with pre-TAVI vWF abnormalities consistent with a type 2A vWF syndrome (ratio vWF:CB/vWF:Ag < 0.7) preferentially improved their vWF function with respect to patients with a normal ratio (relative increase of vWF:CB of 63.8% vs. 3.5%).


CONCLUSIONS
Hemostasis parameters involving vWF are improved after TAVI, especially in patients with pre-existing abnormalities consistent with acquired type 2A von Willebrand syndrome.
Department of Cardiology, University Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France. Electronic address: thibault.caspar@chru-strasbourg.fr.
Thibault
T
Caspar
Department of Cardiology, University Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.
Laurence
L
Jesel
Laboratory of Hematology, Universty Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.
Dominique
D
Desprez
Laboratory of Hematology, Universty Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.
Lélia
L
Grunebaum
Department of Cardiology, University Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.
Hafida
H
Samet
Department of Cardiology, University Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.
Annie
A
Trinh
Department of Cardiology, University Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.
Hélène
H
Petit-Eisenmann
Department of Cardiovascular Surgery, University Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.
Michel
M
Kindo
Department of Cardiology, University Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.
Patrick
P
Ohlmann
Department of Cardiology, University Hospital of Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.
Olivier
O
Morel
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D020141:Hemostatic Disorders / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D011446:Prospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014842:von Willebrand Diseases / Q000150:complications / Q000175:diagnosis*; D014841:von Willebrand Factor / Q000032:analysis*
D014841:von Willebrand Factor