scholarly journals Device-Induced Hemostatic Disorders in Mechanically Assisted Circulation

2021 ◽  
Vol 27 ◽  
pp. 107602962098237
Author(s):  
Shigang Wang ◽  
Bartley P. Griffith ◽  
Zhongjun J. Wu
Keyword(s):  
Shear Stress ◽  
The Body ◽  
Assisted Circulation ◽  
Ventricular Assist ◽  
Acquired Von Willebrand Syndrome ◽  
Platelet Receptor ◽  
Perioperative Bleeding ◽  
Microparticle Formation ◽  
Hemostatic Disorders ◽  
Von Willebrand

Mechanically assisted circulation (MAC) sustains the blood circulation in the body of a patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) or on ventricular assistance with a ventricular assist device (VAD) or on extracorporeal membrane oxygenation (ECMO) with a pump-oxygenator system. While MAC provides short-term (days to weeks) support and long-term (months to years) for the heart and/or lungs, the blood is inevitably exposed to non-physiological shear stress (NPSS) due to mechanical pumping action and in contact with artificial surfaces. NPSS is well known to cause blood damage and functional alterations of blood cells. In this review, we discussed shear-induced platelet adhesion, platelet aggregation, platelet receptor shedding, and platelet apoptosis, shear-induced acquired von Willebrand syndrome (AVWS), shear-induced hemolysis and microparticle formation during MAC. These alterations are associated with perioperative bleeding and thrombotic events, morbidity and mortality, and quality of life in MCS patients. Understanding the mechanism of shear-induce hemostatic disorders will help us develop low-shear-stress devices and select more effective treatments for better clinical outcomes.

Acquired von Willebrand syndrome in patients with ventricular assist device or total artificial heart

2010 ◽  
Vol 103 (05) ◽  
pp. 962-967 ◽  
Author(s):  
Friedhelm Beyersdorf ◽  
Lea Nakamura ◽  
Christoph Benk ◽  
Michael Berchtold-Herz ◽  
Georg Trummer ◽  
...  
Keyword(s):  
Shear Stress ◽  
Artificial Heart ◽  
Binding Capacity ◽  
Rapid Onset ◽  
Cardiac Insufficiency ◽  
Total Artificial Heart ◽  
Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Acquired Von Willebrand Syndrome ◽  
Von Willebrand

SummaryUnexplained bleeding episodes are associated with ventricular assist devices (VAD) and can occur in part due to acquired von Willebrand syndrome (AVWS). AVWS is characterised by loss of high molecular weight (HMW) multimers of von Willebrand factor (VWF) and decreased ratios of collagen binding capacity and ristocetin cofactor activity to VWF antigen. Loss of multimers can occur as VWF is subjected to increased shear stress, which occurs in presence of VADs. We studied 12 patients who required mechanical support of their native heart for terminal cardiac insufficiency. Nine patients underwent placement of a VAD, while three underwent placement of a total artificial heart (TAH), which is connected directly to heart and large cardiac vessels without cannulas. Within one day of VAD implantation, four of five patients evaluated demonstrated loss of HMW multimers and impaired VWF function. AVWS was present within two weeks of implantation in eight of nine patients, and in all seven tested patients after ≥3 months. Patients with different VAD types developed varying severities of AVWS. After VAD ex-plantation, HMW multimers were detectable and VWF function normalised in all patients. AVWS was not observed in the TAH patients studied. Our findings demonstrate that patients with an implanted VAD experience a rapid onset of AVWS that is quickly and completely reversed after device explantation. In addition, TAH patients do not develop AVWS. These results suggest that shear stress associated with exposure of blood to VAD cannulas and tubes may contribute to the development of AVWS.

Management of a Pediatric Patient With a Left Ventricular Assist Device and Symptomatic Acquired von Willebrand Syndrome Presenting for Orthotopic Heart Transplant

2020 ◽  
Vol 24 (4) ◽  
pp. 355-359
Author(s):  
Kaitlin M Flannery ◽  
Komal Kamra ◽  
Katsuhide Maeda ◽  
Paul Shuttleworth ◽  
Christopher Almond ◽  
...  
Keyword(s):  
Left Ventricular Assist Device ◽  
Heart Transplant ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Assist Device ◽  
Ventricular Assist ◽  
Acquired Von Willebrand Syndrome ◽  
Left Ventricular Assist ◽  
Von Willebrand

We present the successful perioperative management of an 11-year-old patient presenting for heart transplant with a left ventricular assist device, symptomatic acquired von Willebrand syndrome, and recent preoperative intracranial hemorrhage. A brief review of the pathophysiology of acquired von Willebrand syndrome is included. As the number of pediatric patients supported with ventricular assist devices continues to increase, the management of symptomatic acquired von Willebrand syndrome during the perioperative period is an important consideration for anesthesiologists.

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