Von Willebrand Factor Multimers during Transcatheter Aortic-Valve Replacement.
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Van Belle Eric, Rauch Antoine, Vincent Flavien, Robin Emmanuel, Kibler Marion, Labreuche Julien, Jeanpierre Emmanuelle, Levade Marie, Hurt Christopher, Rousse Natacha, Dally Jean-Baptiste, Debry Nicolas, Dallongeville Jean, Vincentelli Andre, Delhaye Cedric, Auffray Jean-Luc, Juthier Francis, Schurtz Guillaume, Lemesle Gilles, Caspar Thibault, Morel Olivier, Dumonteil Nicolas, Duhamel Alain, Paris Camille, Dupont-Prado Annabelle, Legendre Paulette, Mouquet Frederic, Marchant Berenice, Hermoire Sylvie, Corseaux Delphine, Moussa Karim, Manchuelle Aurelie, Bauchart Jean-Jacques, Loobuyck Valentin, Caron Claudine, Zawadzki Christophe, Leroy Fabrice, Bodart Jean-Christophe, Staels Bart, Goudemand Jenny, Lenting Peter J, Susen Sophie
Аннотация
METHODS: We enrolled 183 patients undergoing TAVR. Patients with aortic regurgitation after the initial implantation, as identified by means of transesophageal echocardiography, underwent additional balloon dilation to correct aortic regurgitation. HMW multimers and the closure time with adenosine diphosphate (CT-ADP), a point-of-care measure of hemostasis, were assessed at baseline and 5 minutes after each step of the procedure. Mortality was evaluated at 1 year. A second cohort (201 patients) was studied to validate the use of CT-ADP in order to identify patients with aortic regurgitation.
RESULTS: After the initial implantation, HMW multimers normalized in patients without aortic regurgitation (137 patients). Among the 46 patients with aortic regurgitation, normalization occurred in 20 patients in whom additional balloon dilation was successful but did not occur in the 26 patients with persistent aortic regurgitation. A similar sequence of changes was observed with CT-ADP. A CT-ADP value of more than 180 seconds had sensitivity, specificity, and negative predictive value of 92.3%, 92.4%, and 98.6%, respectively, for aortic regurgitation, with similar results in the validation cohort. Multivariable analyses showed that the values for HMW multimers and CT-ADP at the end of TAVR were each associated with mortality at 1 year.
CONCLUSIONS: The presence of HMW-multimer defects and a high value for a point-of-care hemostatic test, the CT-ADP, were each predictive of the presence of aortic regurgitation after TAVR and were associated with higher mortality 1 year after the procedure. (Funded by Lille 2 University and others; ClinicalTrials.gov number, NCT02628509.).