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Von Willebrand Factor Activity Association With Outcomes After Transcatheter Edge-to-Edge Mitral Valve Repair

Sandra Hadjadj1, Philippe Pibarot1, Caroline Gravel1

  • 1Quebec Heart and Lung Institute - Laval University, Quebec, Quebec, Canada.

JACC. Advances
|September 23, 2024
PubMed
Abstract

Insights

Residual mitral regurgitation (MR) after transcatheter edge-to-edge mitral valve repair (TEER) impacts outcomes. The von Willebrand factor (vWF) ratio, not closure time with adenosine diphosphate (CT-ADP), predicts clinical events post-TEER.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Biomarkers

Background:

  • Residual mitral regurgitation (MR) after transcatheter edge-to-edge mitral valve repair (TEER) is linked to adverse clinical outcomes.
  • Mitral regurgitation induces shear stress, altering von Willebrand factor activity (vWF:Act) and closure time with adenosine diphosphate (CT-ADP).

Purpose of the Study:

  • To evaluate CT-ADP for monitoring MR during TEER.
  • To examine the association between vWF markers, residual MR, and clinical events after TEER.

Main Methods:

  • Sixty-five patients undergoing TEER were studied.
  • CT-ADP, vWF:Act/vWF antigen (vWF:Ag) ratio, and MR severity were assessed at various time points.
  • Clinical outcomes (mortality, heart failure hospitalizations) were tracked for one year.

Main Results:

  • Forty-nine percent of patients had residual MR > mild at one month.
  • CT-ADP did not change significantly during the procedure but decreased one hour post-TEER.
  • Elevated baseline vWF:Act/vWF:Ag ratio and its periprocedural changes correlated with adverse clinical outcomes.

Conclusions:

  • CT-ADP is not suitable for real-time MR monitoring during TEER.
  • The vWF:Act/vWF:Ag ratio at baseline and its post-procedure variations are associated with clinical outcomes.
  • External validation of these findings is necessary.
Keywords:
CT-ADPMitraCliptranscatheter mitral valve repairvon Willebrand diseasesvon Willebrand factor

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