Acquired Von Willebrand Factor Deficiency at Patient-Prosthesis Mismatch after AVR Procedure-A Narrative Review

Area of Science:

• Cardiovascular Medicine
• Hematology

Background:

• Acquired von Willebrand factor deficiency is linked to aortic valve stenosis.
• High shear forces in aortic stenosis cause structural changes in von Willebrand factor.
• Similar hemodynamic conditions exist in patients with aortic prosthesis and patient-prosthesis mismatch.

Purpose of the Study:

• To explore the potential for acquired von Willebrand factor deficiency in patients with patient-prosthesis mismatch.
• To investigate if patient-prosthesis mismatch leads to similar von Willebrand factor alterations as aortic stenosis.

Main Methods:

• Review of existing literature on aortic valve stenosis, von Willebrand factor, and patient-prosthesis mismatch.
• Analysis of hemodynamic principles related to blood flow through narrowed orifices and prosthetic valves.

Main Results:

• High shear forces in aortic stenosis alter von Willebrand factor structure, causing deficiency.
• Patient-prosthesis mismatch, characterized by a small prosthesis effective orifice area, creates similar high shear stress conditions.
• These conditions are hypothesized to induce comparable molecular changes in von Willebrand factor.

Conclusions:

• Patient-prosthesis mismatch is a potential cause of acquired von Willebrand factor deficiency.
• Further research is warranted to confirm the association between patient-prosthesis mismatch and von Willebrand factor deficiency.