Hafida Samet

Effects of Transcutaneous Aortic Valve Implantation on Aortic Valve Disease-Related Hemostatic Disorders Involving von Willebrand Factor

BACKGROUND Aortic valve stenosis (AVS) can be complicated by bleeding associated with acquired type 2A von Willebrand syndrome. The association of AVS and gastrointestinal bleeding from angiodysplasia is defined as Heyde syndrome. We sought to evaluate the effect of transcutaneous aortic valve implantation (TAVI) on hemostasis disorders and to assess its effectiveness to treat Heyde syndrome. METHODS We prospectively enrolled 49 consecutive patients with severe AVS addressed for TAVI at our institution. Biological hemostasis parameters involving von Willebrand factor (vWF) were assessed at baseline and 1 week after the procedure. RESULTS At baseline, a significant link between vWF abnormalities and the severity of AVS was evidenced: mean aortic transvalvular gradient was negatively correlated with the levels of vWF antigen (vWF:Ag) (r = -0.29; P < 0.05), vWF ristocetin cofactor activity (r = -0.402; P = 0.006), and vWF collagen-binding activity (vWF:CB; r = -0.441; P = 0.005). One week after the procedure, a significant increase of vWF:Ag, vWF ristocetin cofactor activity, and vWF:CB was evidenced in the whole cohort (respectively, 3.32 vs. 2.29 IU/mL, P < 0.001; 2.98 vs. 1.86 IU/mL, P < 0.001; and 3.16 vs. 2.16 IU/mL, P < 0.001). Patients with pre-TAVI vWF abnormalities consistent with a type 2A vWF syndrome (ratio vWF:CB/vWF:Ag < 0.7) preferentially improved their vWF function with respect to patients with a normal ratio (relative increase of vWF:CB of 63.8% vs. 3.5%). CONCLUSIONS Hemostasis parameters involving vWF are improved after TAVI, especially in patients with pre-existing abnormalities consistent with acquired type 2A von Willebrand syndrome.

Longitudinal 2D strain can help diagnose coronary artery disease in patients with suspected non-ST-elevation acute coronary syndrome but apparent normal global and segmental systolic function

BACKGROUND The clinical work-up of patients presenting with chest pain is a diagnostic challenge. We investigated the diagnostic performance of global (GLS) and territorial (TLS) longitudinal strain to predict coronary artery disease (CAD) in patients presenting with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) but apparent normal global and regional systolic function. METHODS 150 consecutive suspected NSTE-ACS patients were initially screened for inclusion ; 58 patients with normal LVEF (≥55%) and WMSI (=1) were prospectively enrolled. Speckle-tracking echocardiography was performed on admission and all the patients underwent coronary angiography. CAD was defined as the presence of stenosis of >50%. RESULTS CAD was present in 33 patients (57%). LVEF was 60.7±4.6% in group 1 (CAD) and 61.1±5.0% in group 2 (no CAD). Global longitudinal strain (GLS) was altered in group 1 (-16.7±3.4%) as compared to group 2 (-22.4±2.9%, p<0.001). ROC curve analysis showed a high diagnostic value of GLS for the prediction of CAD (AUC=0.92 [0.84-1.00], p=0.0001). TLS was able to discriminate between coronary stenosis in the LAD, LCX or RCA. CONCLUSIONS Longitudinal 2D strain has a good diagnostic value and can efficiently localize the culprit lesion in patients presenting with NSTE-ACS but apparent normal global and regional systolic function.

0353: Impact of TAVI on primary hemostasis, von Willebrand factor and Heyde’s syndrome: a prospective monocenter study

Background Aortic valve stenosis (AVS) can be complicated by bleeding associated with acquired type 2A von Willebrand syndrome. The association of AVS and gastrointestinal bleeding from angiodysplasia is defined as Heyde’s syndrome. We sought to evaluate the impact of TAVI on primary hemostasis disorders and to assess its effectiveness to treat Heyde’s syndrome. Methods We prospectively enrolled 49 consecutive patients with severe AVS referred to our institution for TAVI. Biological primary hemostasis parameters were assessed at baseline and one week after the procedure. Results At baseline, a significant link between vWF abnormalities and the severity of AVS was evidenced: mean aortic transvalvular gradient was negatively correlated with the levels of vWF antigen (vWF: Ag) (r=–0.29, p Conclusion Primary hemostasis parameters involving vWF are improved after TAVI, especially in patients with preexisting abnormalities consistent with acquired type 2A von Willebrand syndrome. Moreover, our observations, although limited to a small single-center study, suggest that Heyde’s syndrome can be cured by TAVI.

TCT-765 Impact Of TAVI On Primary Hemostasis, Von Willebrand Factor And Heyde’s Syndrome: A Prospective Monocenter Study

Aortic valve stenosis (AVS) can be complicated by bleeding associated with acquired type 2A von Willebrand syndrome. The association of AVS and gastrointestinal bleeding from angiodysplasia is defined as Heydes syndrome. We sought to evaluate the impact of TAVI on primary hemostasis disorders and

0258: Comparison of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement in very high risk patients, monocentric registry of an early experience

Introduction The PARTNER trial has shown that TAVI is not inferior to surgical aortic valve replacement (AVR) in high-risk aortic stenosis. However, real life registry comparing TAVI and surgery are lacking. Methods monocentric registry of high-risk patients (lEUROSCORE1 ≥15%) undergoing TAVI (114 patients) or AVR (81 patients) between 2009 and 2013 in our institution. Results Mean age was 84,4 and 83,6 yo (p=NS). TAVI patients had higher EUROSCORE1 (31 vs 24.5%, p Conclusion The present registry results confirm that TAVI is a real alternative to surgery in patients with at high surgical risk. Longer follow up is required to confirm these results. Abstract 0258 – Table. AVR TAVI p n 81 114 Age 83.6 84.4 0.21 Euroscore1 (%) 24.5 31 FEV (%) 57.1 48.5 DTVG (mm) 51 54 0.086 Mean Gradient (mmHg) 53 46 0.008 Creatinin pre (microM/L) 111 138 0.003 Hemoglobin pre (g/100) 12.6 11.6 Death (%) 17.3 9.6 0.12 Vascular complication (%) 0 11.4 0.001 Infection (%) 19 11 0.008 Dialysis (%) 13.6 11.4 0.65 AFIB post (%) 41 20 0.002 Pericardial effusion (% ) 2.5 8.8 0.13 Stroke (%) 4.9 1.8 0.23 Pace Maker (%) 4.9 24.6 Transfusions (%) 80 25

0228: Aortic annulus sizing strategy in TAVI, comparison of echocardiography and CT, impact on aortic regurgitation incidence and patients prognosis

Background Aortic regurgitation (AR) after TAVI is the main limitation of this procedure. The aim of this study was to evaluate i) aortic annulus sizing by CT and/or echocardiography (TTE or TEE) ii) the incidence of AR and its determinism iii) the prognostic impact of AR and other survival predictors. Methods 136 consecutive patients undergoing TAVI were included between 2010 and 2013. The aortic annulus sizing for prosthesis choice was done by TEE in 29 patients and by CT in 107 patients. Aortic valve calcium volume was measured by the volume technique in 67% of patients who have got CT. Follow-up was performed at 1, 6, 12 and 24 months. Results Aortic annulus sizing by TTE and TEE echocardiography (TEE) were well correlated (r=0,73, p=0,0001, n=51) but were significantly lower than CT sizing (p 25%, aortic regurgitation ≥ 2/4, renal failure with creatinin> 130μmol/l, anemia after TAVI Conclusion This study showed that aortic annulus sizing by echocardiography is significantly lower than sizing by CT. AR have an independent prognostic on survival. Prevention of aortic regurgitation is an important issue for the future of this technique.