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| |  Balloon Aortic Valvuloplasty May Reverse Acquired von Willebrand Syndrome Symptoms in Patients With Aortic Valve Stenosis: Presented at SCAI By Carole VanSickle Ellis SAN DIEGO -- May 9, 2010 -- Researchers revealed promising data for doctors with patients who have acquired type II von Willebrand syndrome, which can cause bleeding in patients with severe aortic valve stenosis (AS). Jeffrey Bander, MD, Mount Sinai School of Medicine, New York, New York, reported here that balloon aortic valvuloplasty (BAV) "may be effective in reversing the haematological abnormalities seen in the acquired von Willebrand syndrome of severe AS in patients precluded from surgical aortic valve replacement." The findings were presented May 7 at the 33rd Annual Scientific Sessions of the Society for Cardiovascular Angiography and Interventions (SCAI). The team realised that it is "not an uncommon situation" to have von Willebrand patients who cannot undergo aortic valve replacement (AVR) because of the complications that come with the syndrome. "These patients tend to bleed a lot more postoperatively," Dr. Bander explained to Doctor's Guide, "which is why AVR is not really an option for a lot of them." He added that there are additional stresses on the bodies of these patients, such as putting them on bypass machines, which can also make AVR too dangerous of an option. For this study, the researchers enrolled 110 consecutive patients with severe AS. All patients were scheduled for either BAV (n = 60) or AVR (n = 50). They underwent haematological assessments of factor VIII, von Willebrand factor vWF:antigen (Ag), ristocetin cofactor activity (vWF:RCo), and vWF multimers before the procedure and 24 hours after the valve intervention. These measurements were used to determine the relative effectiveness of the procedures, said Dr. Bander during his presentation on May 7. Patients were also followed clinically for 6 months to determine if there was any change in their bleeding history. The mean transvalvular gradient was 44 mm Hg in AVR patients, and 46 mm Hg in BAV patients (P = .56). Four percent of the AVR patients and 13% of the BAV patients had a history of gastrointestinal bleeding, the most frequent cause of bleeding in the patient population, Dr. Bander noted in his presentation. "The majority of patients reported improvements in their bleeding 6 months after BAV," he said, adding that only 7 patients (3 BAV and 4 AVR) in the entire study reported that their bleeding worsened. Factor VIII, vWF:Ag, and vWF:RCo measurements all increased post-procedure for AVR and BAV patients, while the vWF:RCo/vWF:Ag ratio increased significantly with AVR (43%, P < .0001), and also rose 9% (P < .005) with BAV. An increase in either the vWF:RCo/vWF:Ag ratio or large vWF multimers occurred in 64% (n = 32) of AVR patients and in 48% (n = 29) of BAV patients. "For the first time, we have data that suggests that BAV may be effective in reversing the haematological abnormalities seen in acquired von Willebrand syndrome of severe AS in patients precluded from surgical AVR," said Dr. Bander. "Of course, AVR is still the gold standard and BAV should only be considered when a patient is not a candidate for AVR or as a bridge to another procedure," he noted. The researchers indicated that they had no conflicts of interest to disclose about the funding of this study. [Presentation Title: Balloon Aortic Valvuloplasty and Surgical Aortic Valve Replacement Reverse von Willebrand Factor Abnormalities Associated With Severe Aortic Stenosis. Abstract D-017]
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