von Willebrand Factor and Management of Heart Valve Disease

For decades, numerous observations have shown an intimate relationship between von Willebrand factor (VWF) multimer pro fi le and heart valve diseases (HVD). The current knowledge of the unique biophysical properties of VWF helps us to understand the longstanding observations concerning the bleeding complications in patients with severe HVD. Not only doestheanalysisoftheVWFmultimerpro fi leprovideanexcellentevaluationofHVDseverity,itisalsoastrongpredictorof clinical events. Also of importance, VWF responds within minutes to any signi fi cant change in hemodynamic valve status, making it an accurate marker of the quality of surgical and transcatheter therapeutic interventions. The authors provide in this review a practical, comprehensive, and evidence-based framework of the concept of VWF as a biomarker in HVD, advocating for its implementation into the clinical decision-making process besides usual clinical and imaging evaluation. They also delineate critical knowledge gaps and research priorities to de fi nitely validate this concept. (J

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