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Von Willebrand Factor Multimers during Transcatheter Aortic-Valve Replacement.
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.
Afiliación
  • Van Belle E; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Rauch A; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Vincent F; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Robin E; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Kibler M; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Labreuche J; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Jeanpierre E; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Levade M; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Hurt C; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Rousse N; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Dally JB; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Debry N; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Dallongeville J; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Vincentelli A; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Delhaye C; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Auffray JL; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Juthier F; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Schurtz G; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Lemesle G; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Caspar T; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Morel O; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Dumonteil N; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Duhamel A; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Paris C; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Dupont-Prado A; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Legendre P; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Mouquet F; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Marchant B; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Hermoire S; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Corseaux D; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Moussa K; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Manchuelle A; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Bauchart JJ; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Loobuyck V; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Caron C; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Zawadzki C; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Leroy F; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Bodart JC; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Staels B; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Goudemand J; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Lenting PJ; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
  • Susen S; From the Departments of Cardiology (E.V.B., F.V., C.H., J.-B.D., N. Debry, C.D., J.-L.A., G.S., G.L., B.M., K.M., A.M., J.-J.B., F.L., J.-C.B.), Hematology and Transfusion (A.R., E.J., C.P., A.D.-P., S.H., C.C., C.Z., B.S., J.G., S.S.), and Cardiac Surgery (E.R., N.R., A.V., F.J., V.L.), Centre Hosp
N Engl J Med ; 375(4): 335-44, 2016 Jul 28.
Article en En | MEDLINE | ID: mdl-27464202
ABSTRACT

BACKGROUND:

Postprocedural aortic regurgitation occurs in 10 to 20% of patients undergoing transcatheter aortic-valve replacement (TAVR) for aortic stenosis. We hypothesized that assessment of defects in high-molecular-weight (HMW) multimers of von Willebrand factor or point-of-care assessment of hemostasis could be used to monitor aortic regurgitation during TAVR.

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.).
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Insuficiencia de la Válvula Aórtica / Estenosis de la Válvula Aórtica / Complicaciones Posoperatorias / Factor de von Willebrand / Adenosina Difosfato / Reemplazo de la Válvula Aórtica Transcatéter Tipo de estudio: Diagnostic_studies / Prognostic_studies Límite: Aged / Aged80 / Female / Humans / Male Idioma: En Revista: N Engl J Med Año: 2016 Tipo del documento: Article
Texto completo
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Insuficiencia de la Válvula Aórtica / Estenosis de la Válvula Aórtica / Complicaciones Posoperatorias / Factor de von Willebrand / Adenosina Difosfato / Reemplazo de la Válvula Aórtica Transcatéter Tipo de estudio: Diagnostic_studies / Prognostic_studies Límite: Aged / Aged80 / Female / Humans / Male Idioma: En Revista: N Engl J Med Año: 2016 Tipo del documento: Article