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Von Willebrand Factor Multimers during Transcatheter Aortic-Valve Replacement
Eric Van Belle1, Antoine Rauch1, Flavien Vincent1
1From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hospitalier Universitaire (CHU) Lille, INSERM Unité 1011 (E.V.B., A.R., F.V., E.R., N.R., A.V., F.J., C.P., A.D.-P., F.M., B.M., D.C., C.Z., B.S., J.G., S.S.), Université Lille, INSERM Unité 1011 - European Genomic Institute for Diabetes (E.V.B., A.R., F.V., E.R., N.R., A.V., F.J., C.P., A.D.-P., F.M., B.M., D.C., C.Z., J.G., S.S.), INSERM Unité 1167 (J.D.), Institut Pasteur de Lille (E.V.B., A.R., F.V., E.R., N.R., J.D., A.V., F.J., C.P., A.D.-P., F.M., B.M., D.C., C.Z., J.G., S.S.), and Université Lille, CHU Lille, Equipe d'accueil 2694 - Santé Publique: Epidemiologie et Qualité des Soins (J.L., A.D.), Lille, Pole d'Activité Médico-chirurgicale Cardio-vasculaire, Nouvel Hôpital Civil, CHU, Université de Strasbourg, Strasbourg (M.K., T.C., O.M.), INSERM Unité 1048 and Université Toulouse III (J.L., A.D.), Institut des Maladies Métaboliques et Cardiovasculaires (M.L., N. Dumonteil), and Laboratoire d'Hematologie (M.L.), and Service de Cardiologie (N. Dumonteil), CHU de Toulouse, Toulouse, Unité Mixte de Recherche (UMR), Centre Nationale de la Recherche Scientifique 7213, Laboratoire de Biophotonique et Pharmacologie, Faculté de Pharmacie, Université de Strasbourg, Illkirch (O.M.), and INSERM UMR-S Unité 1176, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre (P.L., P.J.L.) - all in France.
Defects in high-molecular-weight (HMW) multimers and elevated closure time with adenosine diphosphate (CT-ADP) predict aortic regurgitation after transcatheter aortic-valve replacement (TAVR). These findings indicate increased mortality risk one year post-TAVR.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Hematology
Background:
- Postprocedural aortic regurgitation affects 10-20% of patients undergoing transcatheter aortic-valve replacement (TAVR).
- Monitoring for aortic regurgitation during TAVR is crucial for patient outcomes.
- Novel methods for real-time assessment of aortic regurgitation are needed.
Purpose of the Study:
- To investigate the utility of high-molecular-weight (HMW) multimers of von Willebrand factor and point-of-care hemostasis assessment (CT-ADP) in monitoring aortic regurgitation during TAVR.
- To determine if these markers can predict the presence and persistence of aortic regurgitation.
- To evaluate the association of these markers with 1-year mortality after TAVR.
Main Methods:
- 183 patients undergoing TAVR were enrolled, with a validation cohort of 201 patients for CT-ADP.
- Transesophageal echocardiography identified post-implantation aortic regurgitation, prompting balloon dilation.
- HMW multimers and CT-ADP were assessed at baseline and post-procedure steps.
Main Results:
- HMW multimers normalized in patients without aortic regurgitation; defects persisted in those with residual regurgitation.
- CT-ADP showed similar trends, with values >180 seconds demonstrating high sensitivity (92.3%) and specificity (92.4%) for aortic regurgitation.
- Both HMW multimer defects and elevated CT-ADP at TAVR completion were independently associated with 1-year mortality.
Conclusions:
- Defects in HMW multimers and elevated CT-ADP are predictive of aortic regurgitation post-TAVR.
- These markers are associated with increased 1-year mortality, highlighting their prognostic value.
- CT-ADP offers a valuable point-of-care tool for assessing aortic regurgitation during TAVR.
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