Department of Cardiothoracic and Vascular Surgery & Institute of Clinical Medicine, Aarhus University Hospital, Skejby, Denmark.
Scand Cardiovasc J. 2011 Apr;45(2):120-6. doi: 10.3109/14017431.2010.545143. Epub 2010 Dec 29.
Acquired type 2A von Willebrand disease may develop as a consequence of aortic valve stenosis and is associated with varying degrees of bleeding tendency. It remains unknown, whether it portends excess blood loss during aortic valve replacement.
We consecutively enrolled 45 patients with severe aortic valve stenosis undergoing aortic valve replacement. Patients with acquired type 2A von Willebrand disease were identified measuring the von Willebrand factor high molecular weight multimer. Data on the intraoperative, early postoperative, and the total blood loss within 24 hours of surgery was obtained and compared between groups.
Acquired type 2A von Willebrand disease was found in 33% (n = 15/45) of the patients. Baseline characteristics were similar between groups. Patients with acquired type 2A von Willebrand disease neither had excess median intraoperative blood loss (375 ml (interquartile range 100-450 ml) vs. 350 ml (interquartile range 250-500 ml), p = 0.59) nor increased median total blood loss (695 ml (interquartile range 450-850 ml) vs. 752 ml (interquartile range 575-1035 ml), p = 0.41) as compared to patients without acquired type 2A von Willebrand disease.
Acquired type 2A von Willebrand disease was not associated with increased blood loss during aortic valve replacement in patients with severe aortic valve stenosis.
获得性 2A 型血管性血友病可能是由于主动脉瓣狭窄引起的，并伴有不同程度的出血倾向。目前尚不清楚它是否会导致主动脉瓣置换期间失血过多。
我们连续纳入了 45 名接受主动脉瓣置换术的严重主动脉瓣狭窄患者。通过测量血管性血友病因子高分子量多聚体来确定获得性 2A 型血管性血友病患者。获取术中、术后早期和术后 24 小时内的总失血量数据，并在组间进行比较。
33%（n=15/45）的患者存在获得性 2A 型血管性血友病。组间基线特征相似。与无获得性 2A 型血管性血友病的患者相比，患有获得性 2A 型血管性血友病的患者术中中位失血量无明显增加[375ml（四分位间距 100-450ml）vs.350ml（四分位间距 250-500ml），p=0.59]，总中位失血量也无增加[695ml（四分位间距 450-850ml）vs.752ml（四分位间距 575-1035ml），p=0.41]。
在严重主动脉瓣狭窄患者中，获得性 2A 型血管性血友病与主动脉瓣置换期间出血量增加无关。
