获得性血管性血友病因子缺乏症在 HeartMate 3 患者中减少。

Acquired von Willebrand factor deficiency is reduced in HeartMate 3 patients†.

机构信息

Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Helios Clinic, Leipzig, Germany.

Zentrum für Blutgerinnungsstörungen, MVZ Labor Dr. Reising-Ackermann und Kollegen, Leipzig, Germany.

出版信息

Eur J Cardiothorac Surg. 2019 Sep 1;56(3):444-450. doi: 10.1093/ejcts/ezz045.

DOI:10.1093/ejcts/ezz045

PMID:30815698

Abstract

OBJECTIVES

The acquired von Willebrand syndrome (AvWS), which is associated with left ventricular assist device support, is caused by the loss of the von Willebrand factor (vWF) high molecular weight multimers (HMWMs). We investigated whether the implantation of the left ventricular assist device HeartMate 3 (HM 3) is superior to the HeartWare ventricular assist device (HVAD) in preserving the multimeric structure of vWF.

METHODS

In total, 70 patients with implanted HM 3 (n = 35) or HVAD (n = 35) were retrospectively investigated. HMWMs, intermediate molecular weight multimers and low molecular weight multimers were quantified by using a densitometric methodology. vWF antigen, vWF activity and vWF collagen-binding activity, as well as demographic and clinical data, were analysed.

RESULTS

AvWS, which is characterized by a decrease in vWF HMWMs, was found in 97.1% of patients in the HM 3 group and 100% of patients in the HVAD group. Compared to normal pooled plasma, HM 3 induced a reduction in HMWMs (40.7 ± 8.2% vs 26.7 ± 7.5%, P < 0.01) and an increase in low molecular weight multimers (31.3 ± 11.8% vs 42.7 ± 9.8%, P < 0.01), whereas HVAD patients exhibited an increase in the percentage of intermediate molecular weight multimers (28.0 ± 5.0% vs 38.4 ± 7.7%, P < 0.01) in addition to a decrease in the percentage of HMWM (23.0 ± 11.0%, P < 0.01). A comparison of both left ventricular assist device types showed a difference in vWF multimeric structure (HMWMs: P < 0.01, intermediate molecular weight multimer: P = 0.05, low molecular weight multimer: P = 0.03). Furthermore, vWF activity was elevated in patients with an implanted HM 3 device (153.7 ± 54.4%) compared to those with an HVAD device (126.3 ± 39.7%, P = 0.02).

CONCLUSIONS

Patients with an implanted HM 3 had more intact HMWMs and a higher vWF activity during device support. This may reduce the manifestation of AvWS in HM 3 patients and could thus lead to a lower bleeding complication rate.

摘要

目的

获得性 von Willebrand 综合征（AvWS）与左心室辅助装置支持有关，是由 von Willebrand 因子（vWF）高分子量多聚体（HMWM）的丢失引起的。我们研究了 HeartMate 3（HM 3）左心室辅助装置的植入是否优于 HeartWare 心室辅助装置（HVAD）在维持 vWF 的多聚体结构方面。

方法

回顾性分析了 70 例植入 HM 3（n=35）或 HVAD（n=35）的患者。采用密度法定量检测 HMWM、中间分子量多聚体和低分子量多聚体。分析 vWF 抗原、vWF 活性和 vWF 胶原结合活性以及人口统计学和临床数据。

结果

HM 3 组 97.1%和 HVAD 组 100%的患者均存在 AvWS，其特征为 vWF HMWM 减少。与正常混合血浆相比，HM 3 诱导 HMWM 减少（40.7±8.2%对 26.7±7.5%，P<0.01）和低分子量多聚体增加（31.3±11.8%对 42.7±9.8%，P<0.01），而 HVAD 患者中间分子量多聚体的百分比增加（28.0±5.0%对 38.4±7.7%，P<0.01），同时 HMWM 百分比减少（23.0±11.0%，P<0.01）。比较两种左心室辅助装置类型，vWF 多聚体结构存在差异（HMWM：P<0.01，中间分子量多聚体：P=0.05，低分子量多聚体：P=0.03）。此外，植入 HM 3 装置的患者 vWF 活性升高（153.7±54.4%），高于植入 HVAD 装置的患者（126.3±39.7%，P=0.02）。