Abstract 17447: Correction of Acquired Von Willebrand Disease in Patients Undergoing Trans-Catheter Aortic Valve Replacement
Background: Acquired von Willebrand disease (VWD) is a common complication of severe aortic stenosis. Shear stress in calcified valves leads to a reduction of the von Willebrand factor (VWF) high molecular weight multimers (HMWM) which are essential for platelet aggregation. Acquired VWD can successfully be cured by surgical valve replacement. However, the beneficial effect of valve replacement on haemostasis has so far not been demonstrated in patients undergoing trans-catheter aortic valve replacement (TAVR).
Methods: 10 patients with acquired VWD (4 male and 6 female, mean age 83,3 years) with severe aortic valve stenosis (Valve orifice area 40 mmHg) underwent TAVR at our center. At baseline the patients were screened for VWD by plasma electrophoresis of von Willebrand factor (multimer analysis). Changes in the VWF-HMWM concentration where measured again 24 hours after successful TAVR.
Results: Pre-TAVR we observed a positive correlation between aortic gradient and the reduction of VWF-HMWM (Fig. 1). All 10 patients underwent successful TAVR with significant reduction of mean aortic gradient (Fig. 2 line a). When VWF- multimers were measured pre- and post implantation all 10 patients showed a significant increase in the concentration of VWF-HMWM following TAVR (fig 2 line b).
Conclusion: Acquired VWD in high risk patients with severe aortic stenosis can be successfully treated by TAVR.
- © 2012 by American Heart Association, Inc.