Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; The John Paul II Hospital, Krakow, Poland.
Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; The John Paul II Hospital, Krakow, Poland.
Thromb Res. 2021 Feb;198:190-195. doi: 10.1016/j.thromres.2020.12.005. Epub 2020 Dec 16.
Low von Willebrand factor (VWF) increases the risk of bleeding. The objective was to assess the influence of VWF on bleeding after valvular surgery.
We studied 82 consecutive patients in median age of 65.5 years with severe isolated aortic stenosis (AS, n = 62) or mitral stenosis (MS, n = 20), undergoing heart valve surgery in extracorporeal circulation. Preoperatively, we assessed VWF antigen (VWF:Ag) and activity (VWF:RCo), a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13), and fibrinolysis inhibitors.
Compared with AS, MS patients were more frequently female (80 vs. 55%, p = 0.045) with atrial fibrillation (AF) (80 vs. 8%, p < 0.0001), with no difference in age or comorbidities. Median postoperative drainage was 420 ml for AS, and 425 ml for MS (p = 0.37). Patients with AS had lower VWF:RCo (125.8 [88.5-160.8] vs. 188.0 [140.3-207.3] IU/dl, p = 0.003) and VWF:Ag (135.8 [112.0-171.2] vs. 191.7 [147.3-236.4] IU/dl, p = 0.01) than MS patients. Mean VWF:RCo/Ag ratio was 0.88 ± 0.17, with no intergroup differences. ADAMTS13 levels and activity were similar in both groups. In AS, both VWF:RCo and VWF:Ag correlated inversely with maximal (r = -0.39, p = 0.0003 and r = -0.39, p = 0.0004, respectively) and mean (r = -0.40, p = 0.0004 and r = -0.39, p = 0.0006, respectively) transvalvular pressure gradients. There was no difference in perioperative bleeding between patients following mitral and aortic valve surgery, and bleeding was not associated with VWF:Ag or VWF:RCo.
In severe AS, VWF levels and activity correlate inversely with transvalvular pressure gradients, and are lower than in severe degenerative MS, but do not affect blood loss after valvular surgery in extracorporeal circulation.
血管性血友病因子（VWF）水平降低会增加出血风险。本研究旨在评估 VWF 对瓣膜手术后出血的影响。
我们连续纳入了 82 例因重度孤立性主动脉瓣狭窄（AS，n=62）或二尖瓣狭窄（MS，n=20）接受体外循环下心瓣膜手术的患者。术前评估 VWF 抗原（VWF：Ag）和活性（VWF：RCo）、解整合素金属蛋白酶 13（ADAMTS13）和纤维蛋白溶解抑制剂。
与 AS 患者相比，MS 患者更常为女性（80%比 55%，p=0.045），更易发生心房颤动（AF）（80%比 8%，p<0.0001），但两组年龄和合并症无差异。AS 患者术后引流中位数为 420ml，MS 患者为 425ml（p=0.37）。AS 患者 VWF：RCo 水平[125.8（88.5160.8）IU/dl]低于 MS 患者[188.0（140.3207.3）IU/dl，p=0.003]，VWF：Ag 水平[135.8（112.0171.2）IU/dl]也低于 MS 患者[191.7（147.3236.4）IU/dl，p=0.01]。两组 VWF：RCo/Ag 比值的均值为 0.88±0.17，组间无差异。两组 ADAMTS13 水平和活性相似。在 AS 患者中，VWF：RCo 和 VWF：Ag 均与最大跨瓣压力梯度（r=-0.39，p=0.0003 和 r=-0.39，p=0.0004）和平均跨瓣压力梯度（r=-0.40，p=0.0004 和 r=-0.39，p=0.0006）呈负相关。二尖瓣和主动脉瓣手术后的围手术期出血量无差异，且出血量与 VWF：Ag 或 VWF：RCo 无关。
在重度 AS 患者中，VWF 水平和活性与跨瓣压力梯度呈负相关，且低于重度退行性 MS 患者，但不会影响体外循环下心瓣膜手术后的出血量。
