Association between the severity of acquired von Willebrand syndrome and gastrointestinal bleeding after continuous-flow left ventricular assist device implantation

Sakatsume, Ko; Saito, Kazutomo; Akiyama, Mitoshi; Sasaki, Komei; Kawatsu, Satoshi; Takahashi, Goro; Adachi, Osamu; Kawamoto, Shunsuke; Horiuchi, Hisanori; Saiki, Yoshikatsu

doi:10.1093/ejcts/ezy172

Cited by 33 publications

(46 citation statements)

References 19 publications

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“…It designates as a hemostatic disorder the acquired von Willebrand syndrome (AVWS) 4) . AVWS also occurs in other conditions requiring left ventricular assist device implantation 8) .…”

Section: Discussionmentioning

confidence: 99%

Disappearance of Angiodysplasia Following Transcatheter Aortic Valve Implantation in a Patient with Heyde's Syndrome: A Case Report and Review of the Literature

Tsuchiya

Matsumoto

Doman

et al. 2020

JAT

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The official journal of the Japan Atherosclerosis Society and the Asian Pacific Society of Atherosclerosis and Vascular Diseases Case Report An 83-year-old woman with severe aortic stenosis was admitted to our hospital due to heart failure with refractory anemia requiring blood transfusions. She had repetitive bleeding episodes from endoscopically proven angiodysplasia in the stomach. Moreover, she repeatedly underwent endoscopic argon plasma coagulation for hemostasis. Importantly, she had a deficiency of the high-molecular-weight (HMW) multimers of von Willebrand factor (VWF), and she was diagnosed with Heyde's syndrome. After she underwent transcatheter aortic valve implantation (TAVI), aortic valve area and mean left ventricular aorta pressure gradient improved. Notably, endoscopy showed cessation of bleeding at 10 days after TAVI and the disappearance of angiodysplasia at 4 months after TAVI. Even at 2 years after TAVI, follow-up endoscopy showed remaining free of angiodysplasia in the stomach. She experienced no episodes of anemia since TAVI procedure. Additionally, analysis of HMW multimers demonstrated immediate and lasting recovery after TAVI. Recovery of HMW multimers of VWF with cessation of gastrointestinal bleeding following aortic valve replacement has been previously reported in a patient diagnosed with Heyde's syndrome. To the best our knowledge, this is the first case to demonstrate that angiodysplasia disappears after TAVI for a long term with endoscopic images in a patient with Heyde's syndrome. Here, we summarized case reports of patients with Heyde's syndrome that required aortic valve intervention. Cessation of gastrointestinal bleeding and anemia after aortic valve intervention for severe aortic stenosis may be attributed not only to recovery of HMW multimers of VWF but also to the disappearance of angiodysplasia. that is characterized by focal or diffused venous/capillary lesions presenting as bright red ectatic vessels or pulsatile red protrusions, with surrounding venous dilatation or patchy erythema with or without oozing 3, 4) and is known to easily bleed. Heyde's syndrome has been reported to occur in approximately 20% of

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“…It designates as a hemostatic disorder the acquired von Willebrand syndrome (AVWS) 4) . AVWS also occurs in other conditions requiring left ventricular assist device implantation 8) .…”

Section: Discussionmentioning

confidence: 99%

Disappearance of Angiodysplasia Following Transcatheter Aortic Valve Implantation in a Patient with Heyde's Syndrome: A Case Report and Review of the Literature

Tsuchiya

Matsumoto

Doman

et al. 2020

JAT

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“…Fortunately, superficial SSI was observed at the umbilicus incision, yet did not spread to the site of the driveline or pump pocket due to early drainage and washing. With regard to bleeding complications, it is known that LVADs induce acquired von Willebrand syndrome [12,13]. Therefore, surgeons need to be aware that the patients with LVADs tend to bleed even after anti-coagulation therapy is stopped.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic right hemicolectomy for an ascending colon cancer patient with an implantable left ventricular assist device: a case report

et al. 2020

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Background Left ventricular assist devices (LVADs) currently play an important role in the treatment of patients with end-stage heart failure who require a bridge to heart transplantation or destination therapy. With the development and improvement of the LVADs, the morbidity and mortality rates are declining and life expectancies increasing, and the number of patients with LVADs requiring non-cardiac surgery is likely to increase. We present the case of a patient with implantable LVAD who underwent laparoscopic right hemicolectomy for ascending colon cancer. Case description The patient was a 66-year-old man who underwent LVAD implantation as a BTT 3 years prior. He suffered from severe anemia at follow-up, and a colonoscopy revealed ascending colon cancer. The LVAD pump was implanted in the epigastrium. The long C-shaped subfascial driveline tunnel was made, and driveline exit site was located on the left lateral abdominal wall. We assessed the positional relationship between the tumor and the driveline using X-ray and three-dimensional computed tomography (3D CT) images. 3D CT image allowed us to easily identify the location of the driveline, and we determined to perform laparoscopic right hemicolectomy. The port sites were decided upon carefully to avoid the driveline injury, and the driveline was marked on the skin before surgery. There were no adhesions in the abdominal cavity, and both the LVAD and the driveline were observable. The trocars were in nearly the same positions as in a standard laparoscopic right hemicolectomy. During the operation, the LVAD and the driveline did not interfere with the trocars. We successfully completed a standard laparoscopic right hemicolectomy despite hemorrhagic tendency. The patient was discharged without any bleeding complications during the postoperative course. Conclusion Laparoscopic surgery is feasible and safe for patients with LVADs with intensive preoperative simulation and perioperative prevention of infection.

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“…In comparison, the gastrointestinal bleeding that develops at a later phase is considered to be from gastrointestinal angiodysplasia, since it would take some time, possibly several months, for the angiodysplasia to form after LVAD implantation. We have recently demonstrated that all 41 examined LVAD-treated patients exhibited far more severe AVWS compared to that in patients with aortic stenosis by quantitative analysis of AVWS 96) . Twelve patients (approximately 30%) developed gastrointestinal bleeding, where bleeding frequently occurred in patients with a VWF large multimer index below 40% 96) , suggesting a critical role of AVWS in gastrointestinal bleeding in patients treated with LVAD.…”

Section: Avws Caused By Mechanical Circulatory Supportmentioning

confidence: 98%

“…We have recently demonstrated that all 41 examined LVAD-treated patients exhibited far more severe AVWS compared to that in patients with aortic stenosis by quantitative analysis of AVWS 96) . Twelve patients (approximately 30%) developed gastrointestinal bleeding, where bleeding frequently occurred in patients with a VWF large multimer index below 40% 96) , suggesting a critical role of AVWS in gastrointestinal bleeding in patients treated with LVAD. It is noted that four cases developed bleeding within 40 days after LVAD implantation, with 8 cases after 142 days 96) .…”

Section: Avws Caused By Mechanical Circulatory Supportmentioning

confidence: 98%

Acquired von Willebrand Syndrome Associated with Cardiovascular Diseases

Horiuchi

Doman

Kokame

et al. 2019

JAT

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The blood glycoprotein von Willebrand factor (VWF) plays an important role in hemostasis and thrombosis. VWF is produced and secreted as large multimers by endothelial cells and megakaryocytes. It is then cleaved in a sheer-stress dependent manner by a specific protease, ADAMTS13, into multimers consisting of 2–80 subunits. Among VWF multimers, high molecular weight (HMW) multimers play important roles in platelet aggregation. Therefore, their loss induces a hemostatic disorder known as von Willebrand disease (VWD) type 2A. Various cardiovascular diseases, such as aortic stenosis, hypertrophic obstructive cardiomyopathy (HOCM), and several congenital structural diseases, as well as mechanical circulatory support systems, generate excessive high shear stress in the bloodstream. These cause excessive cleavage of VWF multimers resulting in a loss of HMW multimers, known as acquired von Willebrand syndrome (AVWS), a hemostatic disorder similar to VWD type 2A. Bleeding often occurs in the gastrointestinal tract since a fragile angiodysplasia develops associated with these diseases. Radical treatment for AVWS is to remove the pathological high shear causing AVWS.

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Association between the severity of acquired von Willebrand syndrome and gastrointestinal bleeding after continuous-flow left ventricular assist device implantation

Abstract: UMIN000018135.

Cited by 33 publications

References 19 publications

Disappearance of Angiodysplasia Following Transcatheter Aortic Valve Implantation in a Patient with Heyde's Syndrome: A Case Report and Review of the Literature

Disappearance of Angiodysplasia Following Transcatheter Aortic Valve Implantation in a Patient with Heyde's Syndrome: A Case Report and Review of the Literature

Laparoscopic right hemicolectomy for an ascending colon cancer patient with an implantable left ventricular assist device: a case report

Acquired von Willebrand Syndrome Associated with Cardiovascular Diseases

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