Key result
Bicuspid aortic valve morphology was a strong independent predictor for acquired von Willebrand syndrome in severe aortic stenosis (OR 4.06), though TAVI restored vWF function in most patients.
Why the study?
Aortic stenosis can cause acquired von Willebrand syndrome and valve replacement promotes recovery, but the prevalence across different severe aortic stenosis phenotypes and its course after TAVI remained to be investigated.
Does TAVI improve von Willebrand factor function in patients with severe aortic stenosis, and how does bicuspid valve morphology affect the prevalence of acquired von Willebrand syndrome?
Observational (n=143)
No
Does TAVI improve von Willebrand factor function in patients with severe aortic stenosis, and how does bicuspid valve morphology affect the prevalence of acquired von Willebrand syndrome?
Odds Ratio: 4.06 (95% CI 1.27–13.04)
Absolute Event Rate: 53.8% vs 22.3%
p-value: p=0.018
Bicuspid aortic valve morphology is a strong predictor of acquired von Willebrand syndrome in severe aortic stenosis, and TAVI effectively restores vWF function across different AS phenotypes.
May prompt targeted vWF assessment in bicuspid severe AS; leaves open impact on TAVI bleeding outcomes.
Background Aortic stenosis (AS) can cause acquired von Willebrand syndrome (AVWS) and valve replacement has been shown to lead to von Willebrand factor (vWF) recovery. The aim of the current study was to investigate the prevalence of AVWS in different severe AS phenotypes and its course after transcatheter aortic valve implantation (TAVI). Methods 143 patients with severe AS undergoing TAVI were included in the study. vWF function was assessed at baseline, 6 and 24 h after TAVI. AVWS was defined as a reduced vWF:Ac/Ag ratio ≤ 0.7. Phenotypes were classified by tricuspid (TAV) and bicuspid (BAV) valve morphology, mean transvalvular gradient ( P mean ), stroke volume index (SVI), ejection fraction (EF) and indexed effective orifice area (iEOA). Results AVWS was present in 36 (25.2%) patients before TAVI. vWF:Ac/Ag ratio was significantly lower in high gradient compared to low-gradient severe AS [0.78 (IQR 0.67–0.86) vs. 0.83 (IQR 0.74–0.93), p < 0.05] and in patients with BAV compared to TAV [0.70 (IQR 0.63–0.78) vs. 0.81 (IQR 0.71–0.89), p < 0.05]. Normalization of vWF:Ac/Ag ratio was achieved in 61% patients 24 h after TAVI. As in the overall study cohort, vWF:Ac/Ag ratio increased significantly in all severe AS subgroups 6 h after TAVI (each p < 0.05). Regarding binary logistic regression analysis, BAV was the only significant predictor for AVWS. Conclusions BAV morphology is a strong predictor for AVWS in severe AS. TAVI restores vWF function in most patients with severe AS independently of AS phenotype and valve morphology.
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Roth et al. (2022) conducted an observational in Severe symptomatic aortic stenosis (n=143). Bicuspid aortic valve (BAV) morphology vs. Tricuspid aortic valve (TAV) morphology was evaluated on Acquired von Willebrand syndrome (AVWS, defined as vWF:Ac/Ag ratio ≤ 0.7) (OR 4.06, 95% CI 1.27-13.04, p=0.018). Bicuspid aortic valve morphology was a strong independent predictor for acquired von Willebrand syndrome in severe aortic stenosis (OR 4.06), though TAVI restored vWF function in most patients.
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