Effects of Transcutaneous Aortic Valve Implantation on Aortic Valve Disease-Related Hemostatic Disorders Involving von Willebrand Factor

Caspar, Thibault; Jesel, Laurence; Desprez, Dominique; Grunebaum, Lélia; Samet, Hafida; Trinh, Annie; Petit‐Eisenmann, Hélène; Kindo, Michel; Ohlmann, Patrick; Morel, Olivier

doi:10.1016/j.cjca.2015.01.012

Cited by 40 publications

(38 citation statements)

References 23 publications

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“…TAVI led to a normalization of HMW multimers content in patients with prior abnormal multimers and also left HMW multimers in the remainder of the study population unaltered [30]. Similar findings were reported by Caspar et al [31] and Marggraf et al [32]. Spangenberg et al [30] did not show any increase in bleeding of transfusion requirements in patients with severe vWF deficiency undergoing TAVI as opposed to surgical valve repair.…”

Section: Transcatheter Aortic Valve Implantationsupporting

confidence: 83%

Aortic stenosis and anemia with an update on approaches to managing angiodysplasia in 2018

et al. 2020

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Angiodyplasia and aortic stenosis are both conditions that are highly prevalent in elderly people and can often co-exist. Recent studies suggest that this association is related to subtle alterations in plasma coagulation factors. The Von Willebrand factor is the strongest link between aortic stenosis and bleeding associated with gastrointestinal angiodysplasia. With an ageing population, the disease burden of aortic stenosis and its association with angiodysplasia of the bowel makes this an incredibly underdiagnosed yet important condition. Clinicians should be aware of this association when dealing with elderly patients presenting either with unexplained anemia, gastrointestinal bleeding or with aortic stenosis. A high index of suspicion and appropriate diagnostic techniques followed by appropriate and prompt treatment could be life-saving. No clear guidelines exist on management but surgical aortic valve replacement is thought to offer the best hope for long-term resolution of bleeding. With a growing number of technological armamentarium in the management of such patients, especially with the advent of transcatheter aortic valve implantation, new options can be offered even to elderly patients with comorbidities for whom conventional surgery would have been impossible.

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Section: Transcatheter Aortic Valve Implantationsupporting

confidence: 83%

Aortic stenosis and anemia with an update on approaches to managing angiodysplasia in 2018

et al. 2020

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“…Several recent studies demonstrated that HMW-multimers defects were induced by significant PVL that was associated with the increase of flow turbulences and the high shear stress forces [36,37]. This acquired primary hemostasis disorder was then proposed to explain why patients presenting PVL were more prone to bleed [38][39][40]. We have recently demonstrated that prolonged CT-ADP (>180 s), a surrogate marker of HMW-multimers Von Willebrand defect, as measured during the course of the procedure allows a very accurate identification of the presence of paravalvular leak in patients undergoing TAVR [41] but could also identify patients at higher risk of periprocedural but also late MLBCs [29].…”

Section: Discussionmentioning

confidence: 99%

Impact of Incomplete Coronary Revascularization on Late Ischemic and Bleeding Events after Transcatheter Aortic Valve Replacement

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Marchandot

Séverac

et al. 2020

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Background: The impact of coronary artery disease (CAD) and revascularization by percutaneous coronary intervention (PCI) on prognosis in patients undergoing transcatheter aortic valve replacement (TAVR) remain debated. A dismal prognosis in patients undergoing PCI has been associated with elevated baseline SYNTAX score (bSS) and residual SYNTAX score (rSS). The objective was to investigate whether the degree of bSS and rSS impacted ischemic and bleeding events after TAVR. Methods: bSS and rSS were calculated in 311 patients admitted for TAVR. The primary outcome was the occurrence of major adverse cardiac events (MACE), a composite endpoint of myocardial infarction, stroke, cardiovascular death, or rehospitalization for heart failure. The occurrence of late major/life-threatening bleeding complications (MLBCs) and each primary endpoint individually were the secondary endpoints. Results: bSS > 22 was associated with higher occurrence of MACE (p = 0.013). rSS > 8 and bSS > 22 had no impact on overall cardiovascular mortality. rSS > 8 and bSS > 22 were associated with higher rates of myocardial infarction (p = 0.001 and p = 0.004) and late occurrence of MLBCs. Multivariate analysis showed that bSS > 22 (sHR 2.48) and rSS > 8 (sHR 2.35) remained predictors of MLBCs but not of myocardial infarction. Conclusions: Incomplete coronary revascularization and CAD burden did not impact overall and cardiac mortality but constitute predictors of late MLBCs in TAVR patients.

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“…Coagulopathy in Heyde's syndrome is expected to abate when AS is treated and destruction of high-molecularweight vWF multimers stops. With both surgical aortic valve replacement and TAVI, recovery of high-molecularweight vWF multimers has been reported on the day after surgery [2,9,10]. Although vWF multimer analysis is used as a standard diagnostic method for AVWS-2A associated with Heyde's syndrome [11], it is time-consuming and therefore not suitable for chronological evaluation of changes in coagulability during the acute postoperative phase.…”

Section: Discussionmentioning

confidence: 99%

Rotational thromboelastometry-guided perioperative management of coagulation in a patient with Heyde’s syndrome undergoing transcatheter aortic valve implantation

et al. 2019

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Background: Changes in coagulability during the hyperacute phase within 24 h after transcatheter aortic valve implantation (TAVI) for Heyde's syndrome, or aortic stenosis complicated by gastrointestinal angiodysplasia and acquired coagulation dysfunction, have not been clarified. We evaluated perioperative changes in coagulability using rotational thromboelastometry (ROTEM). Case presentation: A female patient with Heyde's syndrome in her 80s underwent TAVI. ROTEM showed coagulation dysfunction before and at 6 h after surgery. Improvements in coagulation function started at 12 h after surgery. Based on ROTEM findings, oral administration of antiplatelet agents was started on the day after surgery. No hemorrhagic complications were observed in the postoperative phase. Conclusions: Evaluation of coagulation function using ROTEM was useful for monitoring perioperative hemostasis and coagulation in this patient.

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Effects of Transcutaneous Aortic Valve Implantation on Aortic Valve Disease-Related Hemostatic Disorders Involving von Willebrand Factor

Cited by 40 publications

References 23 publications

Aortic stenosis and anemia with an update on approaches to managing angiodysplasia in 2018

Aortic stenosis and anemia with an update on approaches to managing angiodysplasia in 2018

Impact of Incomplete Coronary Revascularization on Late Ischemic and Bleeding Events after Transcatheter Aortic Valve Replacement

Rotational thromboelastometry-guided perioperative management of coagulation in a patient with Heyde’s syndrome undergoing transcatheter aortic valve implantation

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