Acquired Von Willebrand Syndrome and Blood Pump Design

Rosenberg, Gerson; Siedlecki, Christopher A.; Jhun, Choon Sik; Weiss, Jason; Manning, Keefe B.; Deutsch, Steven; Pierce, William S.

doi:10.1111/aor.13291

Cited by 17 publications

(24 citation statements)

References 46 publications

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“…8,9,13,18,19,26 In patients with left ventricular assist devices, avWS is associated with increased risks of early and long-term bleeding complications. 8,14 In patients who require temporary MSC, such as ECMO, avWS is also very common and is associated with an increased risk of major bleeding complications. 11,12,15 The severity of the bleeding complications depends on comorbidities, the duration of MCS, and anticoagulation or platelet inhibition during MCS.…”

Section: Discussionmentioning

confidence: 99%

“…Bleeding complications in patients who receive permanent or temporary MCS devices are associated with a risk of acquired von Willebrand syndrome (avWS). [8][9][10][11][12][13][14][15] The von Willebrand factor (vWF) is a multimeric protein and the highest molecular weight multimers play a major role in primary hemostasis by binding to clot-associated collagen and platelet glycoprotein receptors, which helps seal the injured vascular endothelium. Furthermore, vWF is stored in the Weibel-Palade bodies of the endothelium as well as in platelet alpha granules.…”

Section: Introductionmentioning

confidence: 99%

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Role of Acquired Von Willebrand Syndrome in Patients Treated Using Impella RP® Devices: A Retrospective Cohort Study

Oezkur¹,

Reda²,

Rühl³

et al. 2021

Preprint

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Background: Axial flow pumps are standard treatment in cases of cardiogenic shock and high-risk interventions in cardiology and cardiac surgery, although the optimal anticoagulation strategy remains unclear. We evaluated whether laboratory findings could predict bleeding complications and acquired von Willebrand syndrome (avWS) among patients who were treated using axial flow pumps.Methods and Results: We retrospectively evaluated 60 consecutive patients who received Impella® devices (Impella® RP: n=20, Impella® CP/5.0: n=40; Abiomed Inc., Danvers, USA) between January 2019 and December 2020. Thirty-two patients (53.3%) experienced major or fatal bleeding complications (Bleeding Academic Research Consortium score of >3) despite intravenous heparin being used to maintain normal activated partial thromboplastin times (40–50 s). Extensive testing was performed for 28 patients with bleeding complications (87.5%). Relative to patients with left ventricular support, patients with right ventricular support were less likely to develop avWS (87.5% vs. 58.8%, p=0.035). Bleeding was significantly associated with avWS (odds ratio [OR]: 20.8, 95% confidence interval [CI]: 3.3–128.5; p=0.001) and treatment duration (OR: 1.3, 95% CI: 1.09–1.55; p=0.003). Patients with avWS had longer Impella® treatment than patients without avWS (2 days [1–4.7 days] vs. 7.3 days [3.2–13.0 days]). Conclusions: Anticoagulation monitoring based on aPTT was not sufficient to prevent bleeding complications during axial flow pump support. A more targeted anticoagulation monitoring is needed for patients who receive Impella® devices.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Role of Acquired Von Willebrand Syndrome in Patients Treated Using Impella RP® Devices: A Retrospective Cohort Study

Oezkur¹,

Reda²,

Rühl³

et al. 2021

Preprint

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“…Only with continuously pumping rotary pumps does the VWS occur more frequently. Currently, the critical limit is assumed to be 25 Pa. VWS is believed to be one of the major causes of bleeding when using CF-VAD [63][64][65]. The term haemolysis is used to describe the dissolution or degradation of erythrocytes.…”

Section: Bleeding Von-willebrand-syndrome and Haemolysismentioning

confidence: 99%

Review and reflections about pulsatile ventricular assist devices from history to future: concerning safety and low haemolysis—still needed

Köhne

2020

J Artif Organs

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Since the first use of a ventricular assist device in 1963 many extracorporeal and implantable pulsatile blood pumps have been developed. After the invention of continuous flow blood pumps the implantable pulsatile pumps are not available anymore. The new rotary pumps spend a better quality of life because many of the patients can go home. Nevertheless, the extracorporeal pulsatile pumps have some advantages. They are low-cost systems, produce less haemolysis and heart-recovery can be tested easily. Pump failure is easy to realize because the pumps can be observed visually. Pump exchange can be done easily without any chirurgic surgery. As volume displacement pumps they can produce high blood pressure, so they are the only ones suitable for pediatric patients. Therefore, they are indispensable for clinical use today and in the future. In this work, nearly all pulsatile blood pumps used in clinical life are described.

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“…Gerson Rosenberg et al of The Pennsylvania State University College of Medicine, Hershey, PA, USA, reviewed the existence of acquired von Willebrand syndrome (AVWS) in patients with continuous flow left ventricular assist devices (LVADs). AVWS has not been observed to occur in pulsatile devices such as the SynCardia total artificial heart (TAH), the HeartMate XVE, and the Thoratec pulsatile ventricular assist device (PVAD) used as a single pump.…”

Section: Cardiac Support and Blood Pumpsmentioning

confidence: 99%

Artificial Organs 2018: A Year in Review

Malchesky¹

2019

Artificial Organs

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In this Editor's Review, articles published in 2018 are organized by category and summarized. We provide a brief reflection of the research and progress in artificial organs intended to advance and better human life while providing insight for continued application of these technologies and methods. Artificial Organs continues in the original mission of its founders “to foster communications in the field of artificial organs on an international level.” Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. Peer‐reviewed special issues this year included contributions from the 13th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion edited by Dr. Akif Undar, and the 25th Congress of the International Society for Mechanical Circulatory Support edited by Dr. Marvin Slepian. Additionally, many editorials highlighted the worldwide survival differences in hemodialysis and perspectives on mechanical circulatory support and stem cell therapies for cardiac support. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide meaningful suggestions to the author's work whether eventually accepted or rejected. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, John Wiley & Sons for their expert attention and support in the production and marketing of Artificial Organs. We look forward to reporting further advances in the coming years.

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Acquired Von Willebrand Syndrome and Blood Pump Design

Cited by 17 publications

References 46 publications

Role of Acquired Von Willebrand Syndrome in Patients Treated Using Impella RP® Devices: A Retrospective Cohort Study

Role of Acquired Von Willebrand Syndrome in Patients Treated Using Impella RP® Devices: A Retrospective Cohort Study

Review and reflections about pulsatile ventricular assist devices from history to future: concerning safety and low haemolysis—still needed

Artificial Organs 2018: A Year in Review

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