Davis Mary E, Haglund Nicholas A, Tricarico Nicole M, Matafonov Anton, Gailani David, Maltais Simon
From the *Department of Cardiac Surgery, †Division of Cardiovascular Medicine, and ‡Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee.
ASAIO J. 2015 Jan-Feb;61(1):e1-4. doi: 10.1097/MAT.0000000000000157.
All patients supported with continuous flow-left ventricular assist devices (CF-LVADs) develop acquired von Willebrand syndrome due to the loss of von Willebrand factor (vWF) high molecular weight (HMW) multimers and this phenomenon has been associated with clinical manifestation of bleeding diatheses. The precise timing of postoperative recovery of HMW multimers and correction of this condition after CF-LVAD explantation and heart transplantation is unknown. We sought to determine the specific timing of HMW multimer recovery by serially quantifying plasma vWF multimer ratios after CF-LVAD explant and orthotopic heart transplantation (OHT) in a patient implanted with a HeartWare ventricular assist device. Using densitometric analysis of multimer patterns, we demonstrated complete recovery of HMW multimers within the first few hours following CF-LVAD explant and OHT. These findings have critical implications in the context of perioperative bleeding diatheses in patients bridged to transplantation with a CF-LVAD.
所有接受连续血流左心室辅助装置（CF-LVAD）支持的患者都会因血管性血友病因子（vWF）高分子量（HMW）多聚体的丢失而发生获得性血管性血友病综合征，这种现象与出血倾向的临床表现有关。CF-LVAD植入后和心脏移植后HMW多聚体术后恢复的精确时间以及这种情况的纠正尚不清楚。我们试图通过对植入HeartWare心室辅助装置的患者在CF-LVAD取出和原位心脏移植（OHT）后连续定量血浆vWF多聚体比率来确定HMW多聚体恢复的具体时间。通过对多聚体模式的光密度分析，我们证明了在CF-LVAD取出和OHT后的最初几个小时内HMW多聚体完全恢复。这些发现对于使用CF-LVAD过渡到移植的患者围手术期出血倾向具有关键意义。
