Jahangiri Parsa, Veen Kevin M, van Moort Iris, Bunge Jeroen H, Constantinescu Alina, Sjatskig Jelena, de Maat Moniek, Kluin Jolanda, Leebeek Frank, Caliskan Kadir
From the Department of Cardiology.
Cardiothoracic Surgery.
ASAIO J. 2025 Jan 1;71(1):27-35. doi: 10.1097/MAT.0000000000002250. Epub 2024 Jun 19.
Hemocompatibility-related adverse events (HRAEs), particularly gastrointestinal bleeding, remain a frequent complication after left ventricular assist device (LVAD) implantation. The current study sought to describe and analyze whether early (<60 days) postoperative von Willebrand factor (VWF) activity assays predict the risk of gastrointestinal bleeding and stroke. A prospective single-center study including 74 HeartMate 3 device recipients between 2016 and 2023 was undertaken. The postoperative trajectory of the VWF profile was analyzed using linear mixed-effect models and Cox models were used to quantify associations between an early postoperative dip (≤0.7) in VWF activity assay measurements and late outcomes. Preoperatively, the mean VWF:Activity (Act)/Antigen (Ag) and VWF:Collagen Binding (CB)/Ag ratios were 0.94 (95% confidence interval [CI] = 0.81-1.02) and 0.95 (95% CI = 0.80-1.03), respectively, decreasing to 0.66 (95% CI = 0.57-0.73) and 0.67 (95% CI = 0.58-0.74) within 40 days ( p < 0.05). In patients with VWF:CB/Ag and VWF:Act/Ag ratios ≤0.7 significantly more gastrointestinal bleeding (hazard ratio [HR]: 2.53; 95% CI = 1.1-5.8, and HR: 3.7; 95% CI = 1.5-9.2, respectively) and hemorrhagic stroke events (HR: 3.5; 95% CI = 1.6-7.6 and HR: 4.9; 95% CI = 2.1-11.7, respectively) were observed throughout the entire late (>60 days) postoperative period. In patients with VWF:Act/Ag ratio ≤0.7 less ischemic stroke events were observed (HR: 0.11; 95% CI = 0.01-0.85). In conclusion, VWF:Act/Ag and VWF:CB/Ag ratios ≤0.7 in the early postoperative phase can be used as biomarkers to predict HRAEs during long-term LVAD support.
与血液相容性相关的不良事件（HRAEs），尤其是胃肠道出血，仍是左心室辅助装置（LVAD）植入术后常见的并发症。本研究旨在描述和分析术后早期（<60天）血管性血友病因子（VWF）活性检测是否能预测胃肠道出血和中风的风险。开展了一项前瞻性单中心研究，纳入了2016年至2023年间74例接受HeartMate 3装置的患者。使用线性混合效应模型分析VWF谱的术后轨迹，并使用Cox模型量化术后早期VWF活性检测值下降（≤0.7）与晚期结局之间的关联。术前，VWF:活性（Act）/抗原（Ag）和VWF:胶原结合（CB）/Ag的平均比值分别为0.94（95%置信区间[CI]=0.81-1.02）和0.95（95%CI=0.80-1.03），在40天内降至0.66（95%CI=0.57-0.73）和0.67（95%CI=0.58-0.74）（p<0.05）。在VWF:CB/Ag和VWF:Act/Ag比值≤0.7的患者中，在整个术后晚期（>60天）观察到明显更多的胃肠道出血事件（风险比[HR]：2.53；95%CI=1.1-5.8，以及HR：3.7；95%CI=1.5-9.2）和出血性中风事件（HR：3.5；95%CI=1.6-7.6以及HR：4.9；95%CI=2.1-11.7）。在VWF:Act/Ag比值≤0.7的患者中，观察到较少的缺血性中风事件（HR：0.11；95%CI=0.01-0.85）。总之，术后早期VWF:Act/Ag和VWF:CB/Ag比值≤0.7可作为生物标志物，用于预测长期LVAD支持期间的HRAEs。
