- 1 A Historical Perspective on the Development of Mechanical Circulatory Support Devices
- 2 Indications for Mechanical Circulatory Support
- 3 Frailty: Assessment and Associations with Outcomes
- 4 Palliative Care in Mechanical Circulatory Support
- 5 Psychosocial Assessment of Patients Considered for Mechanical Circulatory Support
- 6 Left Ventricular Assist Device Backup for Conventional Surgery
- 7 Preoperative Strategies for Optimizing Mechanical Circulatory Support
- 8 Mechanical Circulatory Support in Patients with Pulmonary Hypertension
- 9 Selecting Children for Mechanical Circulatory Support
- 10 Device Selection for Short- and Long-Term Mechanical Circulatory Support
- 11 The HeartMate II™ Continuous-Flow Left Ventricular Assist System
- 12 The Abbott HeartMate 3™ Left Ventricular Assist System
- 13 The HeartWare<sup>™</sup> HVAD<sup>™</sup> Left Ventricular Assist Device
- 14 The Medtronic Miniature Left Ventricular Assist Device (MVAD)<sup>™</sup> System
- 15 The ReliantHeart aVAD<sup>©</sup>
- 16 The Syncardia Total Artificial Heart
- 17 Counterpulsation Circulatory Assist Devices
- 18 Abiomed Impella Platform
- 19 The Tandem: Life System
- 20 The Abbott CentriMag™ Acute Circulatory Support System and the HeartMate Percutaneous Heart Pump™
- 21 Extracorporeal Membrane Oxygenation
- 22 The Berlin Heart Ventricular Assist Devices
- 23 EVAHEART<sup>®</sup> 2 Left Ventricular Assist Device System
- 24 Anesthesia
- 25 Perfusion Considerations
- 26 Echocardiography in Left Ventricular Assist Device Recipients
- 27 Implantation of Continuous-Flow Left Ventricular Assist Devices via Sternotomy Technical Considerations
- 28 The Less-Invasive (Lateral) Approach to Left Ventricular Device Implantation
- 29 Concomitant Cardiac Valve Procedures with Circulatory Support Device Implantation
- 30 Providing Mechanical Support to Children Size and Anatomical Considerations
- 31 Postoperative Management after Assist Device Implantation
- 32 Anticoagulation Strategies for Patients on Mechanical Circulation Support
- 33 Acquired von Willebrand Syndrome with Mechanical Circulatory Support
- 34 Gastrointestinal Bleeding in Patients with Left Ventricular Assist Devices
- 35 Pump Thrombosis
- 36 Infectious Complications of Mechanical Circulatory Support
- 37 Cerebral Blood Flow and Stroke in Patients with Left Ventricular Assist Devices
- 38 Right Heart Dysfunction
- 39 Renal Failure and Mechanical Circulatory Support Devices
- 40 Arrhythmia/Ventricular Tachycardia Ablation
- 41 Aortic Regurgitation in Patients with Left Ventricular Assist Devices
- 42 Modalities of Left Ventricular Assist Device Optimization
- 43 The CardioMEMS Heart Failure Monitoring System
- 44 Mechanical Circulatory Support as a Bridge to Recovery
- 45 Cardiac and Physical Rehabilitation
- 46 The VAD Coordinator Roles and Responsibilities in Caring for Patients with Ventricular Assist Devices
(p. 269) Acquired von Willebrand Syndrome with Mechanical Circulatory Support
- Chapter:
- (p. 269) Acquired von Willebrand Syndrome with Mechanical Circulatory Support
- Author(s):
Evan C. Klein
and Lisa Baumann Kreuziger
- DOI:
- 10.1093/med/9780190909291.003.0033
Acquired von Willebrand syndrome occurs in the setting of mechanical circulatory support from device-associated sheer stress, which changes the quaternary structure of high-molecular-weight von Willebrand factor multimers, exposing the cleavage site for ADAMTS-13. Once cleaved, lower-molecular-weight multimers lose their affinity for binding platelets, increasing the susceptibility to bleeding complications. Acquired von Willebrand syndrome has been described in all the currently approved continuous-flow mechanical circulatory support devices. Although theoretically the risk of von Willebrand factor multimer degradation is increased at the higher rotational speeds of axial-flow pumps, disease severity does not differ greatly between axial- and centrifugal-flow devices. Disease-specific therapies for acquired von Willebrand syndrome have not been well studied in patients supported by mechanical circulatory devices. Case reports and case series have noted beneficial effects from octreotide, doxycycline, desmopressin, or Humate-P treatment for patients with recurrent severe bleeding.
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- 1 A Historical Perspective on the Development of Mechanical Circulatory Support Devices
- 2 Indications for Mechanical Circulatory Support
- 3 Frailty: Assessment and Associations with Outcomes
- 4 Palliative Care in Mechanical Circulatory Support
- 5 Psychosocial Assessment of Patients Considered for Mechanical Circulatory Support
- 6 Left Ventricular Assist Device Backup for Conventional Surgery
- 7 Preoperative Strategies for Optimizing Mechanical Circulatory Support
- 8 Mechanical Circulatory Support in Patients with Pulmonary Hypertension
- 9 Selecting Children for Mechanical Circulatory Support
- 10 Device Selection for Short- and Long-Term Mechanical Circulatory Support
- 11 The HeartMate II™ Continuous-Flow Left Ventricular Assist System
- 12 The Abbott HeartMate 3™ Left Ventricular Assist System
- 13 The HeartWare<sup>™</sup> HVAD<sup>™</sup> Left Ventricular Assist Device
- 14 The Medtronic Miniature Left Ventricular Assist Device (MVAD)<sup>™</sup> System
- 15 The ReliantHeart aVAD<sup>©</sup>
- 16 The Syncardia Total Artificial Heart
- 17 Counterpulsation Circulatory Assist Devices
- 18 Abiomed Impella Platform
- 19 The Tandem: Life System
- 20 The Abbott CentriMag™ Acute Circulatory Support System and the HeartMate Percutaneous Heart Pump™
- 21 Extracorporeal Membrane Oxygenation
- 22 The Berlin Heart Ventricular Assist Devices
- 23 EVAHEART<sup>®</sup> 2 Left Ventricular Assist Device System
- 24 Anesthesia
- 25 Perfusion Considerations
- 26 Echocardiography in Left Ventricular Assist Device Recipients
- 27 Implantation of Continuous-Flow Left Ventricular Assist Devices via Sternotomy Technical Considerations
- 28 The Less-Invasive (Lateral) Approach to Left Ventricular Device Implantation
- 29 Concomitant Cardiac Valve Procedures with Circulatory Support Device Implantation
- 30 Providing Mechanical Support to Children Size and Anatomical Considerations
- 31 Postoperative Management after Assist Device Implantation
- 32 Anticoagulation Strategies for Patients on Mechanical Circulation Support
- 33 Acquired von Willebrand Syndrome with Mechanical Circulatory Support
- 34 Gastrointestinal Bleeding in Patients with Left Ventricular Assist Devices
- 35 Pump Thrombosis
- 36 Infectious Complications of Mechanical Circulatory Support
- 37 Cerebral Blood Flow and Stroke in Patients with Left Ventricular Assist Devices
- 38 Right Heart Dysfunction
- 39 Renal Failure and Mechanical Circulatory Support Devices
- 40 Arrhythmia/Ventricular Tachycardia Ablation
- 41 Aortic Regurgitation in Patients with Left Ventricular Assist Devices
- 42 Modalities of Left Ventricular Assist Device Optimization
- 43 The CardioMEMS Heart Failure Monitoring System
- 44 Mechanical Circulatory Support as a Bridge to Recovery
- 45 Cardiac and Physical Rehabilitation
- 46 The VAD Coordinator Roles and Responsibilities in Caring for Patients with Ventricular Assist Devices