TY - JOUR
T1 - Development of acquired von willebrand syndrome during short-term micro axial pump support
T2 - Implications for bleeding in a patient bridged to a long-term continuous-flow left ventricular assist device
AU - Davis, Mary E.
AU - Haglund, Nicholas A.
AU - Tricarico, Nicole M.
AU - Keebler, Mary E.
AU - Maltais, Simon
PY - 2014
Y1 - 2014
N2 - 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.
AB - 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.
KW - Acquired Von Willebrand syndrome
KW - hemostasis
KW - left ventricular assist device
KW - perioperative bleeding risk
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U2 - 10.1097/MAT.0000000000000069
DO - 10.1097/MAT.0000000000000069
M3 - Article
C2 - 24614358
AN - SCOPUS:84900447290
SN - 1058-2916
VL - 60
SP - 355
EP - 357
JO - ASAIO Journal
JF - ASAIO Journal
IS - 3
ER -