0353: Impact of TAVI on primary hemostasis, von Willebrand factor and Heyde’s syndrome: a prospective monocenter study

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Aortic valve stenosis (AVS) can be complicated by bleeding associated with acquired type 2A von Willebrand syndrome. The association of AVS and gastrointestinal bleeding from angiodysplasia is defined as Heyde’s syndrome. We sought to evaluate the impact of TAVI on primary hemostasis disorders and to assess its effectiveness to treat Heyde’s syndrome. We prospectively enrolled 49 consecutive patients with severe AVS referred to our institution for TAVI. Biological primary hemostasis parameters were assessed at baseline and one week after the procedure. At baseline, a significant link between vWF abnormalities and the severity of AVS was evidenced: mean aortic transvalvular gradient was negatively correlated with the levels of vWF antigen (vWF: Ag) (r=–0.29, p<0.05), vWF ristocetin cofactor activity (vWF:RCo) (r=–0.402, p=0.006) and vWF collagen-binding activity (vWF:CB) (r=–0.441, p=0.005). One week after the procedure, a significant increase of vWF:Ag, vWF:RCo, and vWF:CB was evidenced in the whole cohort (respectively 3.32 vs 2.29 IU/mL, p<0.001; 2.98 vs 1.86 IU/mL, p<0.001; 3.16 vs 2.16 IU/mL, p<0.001). Patients with pre-TAVI vWF abnormalities consistent with a type 2A vWF syndrome (ratio vWF:CB/ vWF:Ag <0.7) preferentially improved their vWF function with respect to patients with a normal ratio (relative increase of vWF:CB of 63.8% vs 3.5%). Primary hemostasis parameters involving vWF are improved after TAVI, especially in patients with preexisting abnormalities consistent with acquired type 2A von Willebrand syndrome. Moreover, our observations, although limited to a small single-center study, suggest that Heyde’s syndrome can be cured by TAVI.