Perioperative onset of acquired von Willebrand syndrome: Comparison between HVAD, HeartMate II and on-pump coronary bypass surgeryReportar como inadecuado




Perioperative onset of acquired von Willebrand syndrome: Comparison between HVAD, HeartMate II and on-pump coronary bypass surgery - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Objectives

Acquired von Willebrand syndrome AvWS is associated with postoperative bleeding complications in patients with continuous flow left ventricular assist devices CF-LVADs. The aim of this study is to analyze the perioperative vWF profile comparing an axial pump HMII to a centrifugal pump HVAD regarding the correlation between perioperative occurrence of AvWS, early- and late-postoperative bleeding events.

Methods

From July 2013 until March 2015 blood samples of 33 patients 12 HMII- 8 HVAD- 13 controls were prospectively collected at 12 different time points and analyzed for the vWF antigen vWF:Ag, its activity vWF:Ac and the vWF:Ac-vWF:Ag-ratio vWF:ratio. The follow up period for postoperative bleeding events was from July 2013 until July 2016.

Results

Postoperatively, there was no difference in the vWF-profile between HVAD and HMII groups. However, a subgroup of patients already had significantly lower vWF:ratios preoperatively. Postoperatively, both CF-LVAD groups presented significantly lower vWF:ratios compared to the control group. Bleeding events per patient-year did not differ between the two groups HMII vs. HVAD: 0.67 vs. 0.85, p = 0.685. We detected a correlation between vWF:ratio <0.7at LVAD-start r = -0.583, p = 0.006 or at the end of surgery r = -0.461, p = 0.035 and the occurrence of pericardial tamponade. In the control group, the drop in both vWF:Ag and vWF:Ac recovered immediately postoperatively above preoperative values.

Conclusion

A subgroup of patients with end-stage heart failure already suffers AvWS preoperatively. In both CF-LVAD groups, AvWS begins immediately after surgery. Intraoperative vWF:ratios <0.7 correlate with higher incidences of pericardial tamponade and re-operation. The presumably dilutive effect of the heart lung machine on vWF vanishes immediately at the end of surgery, possibly as part of an acute-phase response.



Autor: Christina Feldmann , Rashad Zayat , Andreas Goetzenich, Ali Aljalloud, Eva Woelke, Judith Maas, Lachmandath Tewarie, Thomas Schmi

Fuente: http://plos.srce.hr/



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