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Reduced continuous-flow left ventricular assist device speed does not decrease von Willebrand factor degradation.

Jooeun Kang¹, David M Zhang¹, David J Restle¹

¹Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.

The Journal of Thoracic and Cardiovascular Surgery

|March 15, 2016

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Reducing left ventricular assist device (LVAD) speed did not significantly alter von Willebrand factor (vWF) degradation. This suggests that lowering LVAD speed may not be an effective strategy to reduce bleeding complications related to vWF deficiency.

Area of Science:

Cardiovascular Science
Biomedical Engineering
Hematology

Background:

Nonsurgical bleeding is a common complication in patients with continuous-flow left ventricular assist devices (LVADs).
Abnormal von Willebrand factor (vWF) metabolism is implicated, with shear stress from LVADs potentially accelerating vWF degradation.
The impact of LVAD speed on vWF degradation remains unclear, hindering effective bleeding management strategies.

Purpose of the Study:

To investigate the relationship between continuous-flow LVAD speed and von Willebrand factor (vWF) degradation.
To determine if reducing LVAD speed decreases shear stress and subsequent vWF degradation.
To provide data supporting or refuting the clinical practice of reducing LVAD speed for bleeding management.

Main Methods:

Keywords:

bleeding heart failure left ventricular assist device mechanical circulatory support shear stress von Willebrand factor

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Collected whole blood from LVAD patients (n=10) pre- and post-implantation to assess in vivo vWF degradation.
Circulated donor blood (n=30) in an ex vivo HeartMate II mock loop at varying speeds (11,400, 10,000, 8600 rpm).
Analyzed vWF multimers and degradation fragments using electrophoresis and immunoblotting; statistical analysis included paired t-tests and ANOVA.

Main Results:

LVAD support in patients led to reduced large vWF multimers and increased vWF degradation fragments.
vWF degradation patterns in LVAD patients mirrored those in the ex vivo mock loop.
No statistically significant difference in vWF degradation was observed across different LVAD speeds (rpm) or compared to LVAD patients.

Conclusions:

Reduced LVAD speed, within the tested clinical range, did not significantly decrease vWF degradation.
Lowering LVAD speed alone may not be sufficient to mitigate vWF degradation and associated bleeding events.
Further research is needed to explore alternative strategies for managing LVAD-associated bleeding complications.