Impact of Cancer in Patients Undergoing Transcatheter Aortic Valve Replacement: A Single-Center Study

• Published in: JACC CardioOncology 2020-12, Vol.2 (5), p.735-743
• Main Authors: Lind, Alexander, Totzeck, Matthias, Mahabadi, Amir A, Jánosi, Rolf A, El Gabry, Mohamed, Ruhparwar, Arjang, Mrotzek, Simone M, Hinrichs, Lena, Akdeniz, Merve, Rassaf, Tienush, Mincu, Raluca I
• Format: Article
• Language: English
• Subjects: Original Research
• ISSN: 2666-0873
• DOI: 10.1016/j.jaccao.2020.11.008

BACKGROUNDThe use of transcatheter aortic valve replacement (TAVR) in cancer survivors and patients with active cancer (AC) in cancer survivors and patients with active cancer (AC) is expanding, suggesting a need to adjust the indications and risk assessment pre-TAVR. OBJECTIVESThe purpose of this study was to determine the impact of cancer on peri-procedural complications and survival in a long-term, single-center cohort of patients treated with TAVR. METHODSPatients treated with TAVR between January 2006 and December 2018 were grouped as follows: controls (patients without cancer), stable cancer (SC), and AC. The primary endpoints were peri-procedural complications and 30-day survival. A secondary endpoint was 10-year survival. RESULTSA total of 1,088 patients (age 81 ± 5 years, 46.6% men) treated with transfemoral TAVR were selected: 839 controls, 196 SC, and 53 AC. Predominant malignancies were breast, gastrointestinal, and prostate cancer. No differences were observed between patients with cancer and controls regarding peri-procedural complications. Patients with AC had similar 30-day survival compared with controls and SC (94.3% vs. 93.3% vs. 96.9%, p = 0.161), but as expected, reduced 10-year survival. AC was associated with a 1.47 (95% CI 1.16 to 1.87) fold increased risk of all-cause 10-year mortality in multivariable adjusted models. CONCLUSIONSTAVR should be performed in patients with cancer when indicated, considering that patients with cancer have similar periprocedural complications and short-term survival compared with control patients. However, patients with AC have worse 10-year survival. Future studies are needed to define cancer-specific determinants of worse long-term survival.