Relationship between Von Willebrand Factor and Gastrointestinal Bleeding Compared EVAHEART and HeartMate II

Abstract

Purpose Gastrointestinal (GI) bleeding is crucial issue in long-term management of continuous-flow (CF) left ventricular assist device (LVAD) patients, and it has been reported that lack of high-molecular-weight (HMW) von Willebrand factor (vWF) multimers is one of the most critical cause of GI bleeding. Aim of this study was to investigate a relationship between the prevalence of GI bleeding in LVAD and the effects of vWF activities including the comparison between EVAHEART and HeartMate II. Methods We performed EVAHEART implantation for 36 patients and HeartMate II for 6 patients with advanced heart failure (INTERMACS profile I - IV, eligible for heart transplantation, mean age 43 years old) between March 2011 and December 2017. Laboratory data of factor VIII-antigen (VIII-Ag), vWF ristocetin cofactor (RCo), and the presence of HMW-vWF multimers were measured post-operatively over time. The primary outcome was comparison of VIII-Ag and vWF RCo between two groups. The analysis was performed using Wilcoxon signed-rank test and a two-factor repeated-measures analysis of variance. Results Thirty patients (71%) survived with a mean follow-up period of 1157 (range 14-2255) days, and 25 of them underwent heart transplantation. There was no significant difference of survival rate (75% vs 67%, p=0.67), the loss of HMW-vWF multimers (3% vs 0%, p=0.68), and the incidence of GI bleeding (8% vs 0%, p=0.46). The EVAHEART group showed higher vWF RCo than the HeartMate II (p Conclusion This result suggested that EVAHEART maintained vWF RCo, and there was a possibility that EVAHEART provided low incidence of GI bleeding by means of maintenance the HMW-vWF multimers.