Development of Acquired von Willebrand Syndrome During Short-Term Micro Axial Pump Support: Implications for Bleeding in a Patient Bridged to a Long-Term Continuous-Flow Left Ventricular Assist Device

Davis, Mary E.; Haglund, Nicholas A.*; Tricarico, Nicole M.; Keebler, Mary E.*; Maltais, Simon

doi: 10.1097/MAT.0000000000000069
Case Reports

Percutaneous continuous-flow (CF) micro axial blood pumps, like the Impella 5.0, are commonly used for short-term (ST) mechanical circulatory support in patients with acute decompensated heart failure. The Impella device often serves as a bridge to implantation of a long-term (LT) CF left ventricular assist device (CF-LVAD), such as the centrifugal-flow HeartWare (HVAD). All patients supported with axial CF-LVADs develop acquired von Willebrand syndrome (AVWS) as a result of mechanical shear stress. Increased shear stress leads to excessive proteolysis of von Willebrand factor and loss of high molecular weight multimers, thus contributing to platelet dysfunction and increased gastrointestinal bleeding. Bleeding events associated with AVWS have been reported in patients supported with LT CF-LVADs; however, the relation between early perioperative bleeding complications and AVWS remains poorly characterized in ST CF-LVADs. We sought to describe the relation between the development of AVWS and excessive intraoperative bleeding in a patient who was sequentially bridged with an ST micro axial device to a LT centrifugal CF-LVAD. This case highlights the importance of monitoring these hemostatic changes when bridging to LT CF-LVADs.

From the *Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; and Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.

Submitted for consideration December 20, 2013; accepted for publication in revised form February 20, 2014.

Disclosure: Dr. Haglund is funded by the T32HL007411 Training Grant in Cardiovascular Research. Dr. Maltais, Ms. Davis, and Ms. Tricarico are partially funded by AHA Award Number 14CRP18900004 in Clinical & Population Research.

Reprint Requests: Simon Maltais, MD, PhD, Department of Cardiac Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, MCE 5th Floor, Nashville, TN 37232–8808. Email: simon.maltais@vanderbilt.edu.

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