Development of acquired von willebrand syndrome during short-term micro axial pump support: Implications for bleeding in a patient bridged to a long-term continuous-flow left ventricular assist device

Mary E. Davis, Nicholas A. Haglund, Nicole M. Tricarico, Mary E. Keebler, Simon Maltais

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

Percutaneous continuous-flow (CF) micro axial blood pumps, like the Impella 5.0, are commonly used for short-term (ST) mechanical circulatory support in patients with acute decompensated heart failure. The Impella device often serves as a bridge to implantation of a long-term (LT) CF left ventricular assist device (CF-LVAD), such as the centrifugal-flow HeartWare (HVAD). All patients supported with axial CF-LVADs develop acquired von Willebrand syndrome (AVWS) as a result of mechanical shear stress. Increased shear stress leads to excessive proteolysis of von Willebrand factor and loss of high molecular weight multimers, thus contributing to platelet dysfunction and increased gastrointestinal bleeding. Bleeding events associated with AVWS have been reported in patients supported with LT CF-LVADs; however, the relation between early perioperative bleeding complications and AVWS remains poorly characterized in ST CF-LVADs. We sought to describe the relation between the development of AVWS and excessive intraoperative bleeding in a patient who was sequentially bridged with an ST micro axial device to a LT centrifugal CF-LVAD. This case highlights the importance of monitoring these hemostatic changes when bridging to LT CF-LVADs.

Original languageEnglish (US)
Pages (from-to)355-357
Number of pages3
JournalASAIO Journal
Volume60
Issue number3
DOIs
StatePublished - Jan 1 2014

Keywords

  • Acquired Von Willebrand syndrome
  • hemostasis
  • left ventricular assist device
  • perioperative bleeding risk

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering
  • Biomaterials
  • Biomedical Engineering

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