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Published on: May 21, 2017
Transcatheter Aortic Valve Replacement in Oncology Patients With Severe Aortic Stenosis
Uri Landes1, Zaza Iakobishvili1, Daniella Vronsky2
1Cardiology Department, Rabin Medical Center, Petah Tikva, Israel; Cardiology Department, Carmel Medical Center, Haifa, Israel.
Objectives:
The authors sought to collect data on contemporary practice and outcome of transcatheter aortic valve replacement (TAVR) in oncology patients with severe aortic stenosis (AS).
Background:
Oncology patients with severe AS are often denied valve replacement. TAVR may be an emerging treatment option.
Methods:
A worldwide registry was designed to collect data on patients who undergo TAVR while having active malignancy. Data from 222 cancer patients from 18 TAVR centers were compared versus 2,522 "no-cancer" patients from 5 participating centers. Propensity-score matching was performed to further adjust for bias.
Results:
Cancer patients' age was 78.8 ± 7.5 years, STS score 4.9 ± 3.4%, 62% men. Most frequent cancers were gastrointestinal (22%), prostate (16%), breast (15%), hematologic (15%), and lung (11%). At the time of TAVR, 40% had stage 4 cancer. Periprocedural complications were comparable between the groups. Although 30-day mortality was similar, 1-year mortality was higher in cancer patients (15% vs. 9%; p < 0.001); one-half of the deaths were due to neoplasm. Among patients who survived 1 year after the TAVR, one-third were in remission/cured from cancer. Progressive malignancy (stage III to IV) was a strong mortality predictor (hazard ratio: 2.37; 95% confidence interval: 1.74 to 3.23; p < 0.001), whereas stage I to II cancer was not associated with higher mortality compared with no-cancer patients.
Conclusions:
TAVR in cancer patients is associated with similar short-term but worse long-term prognosis compared with patients without cancer. Among this cohort, mortality is largely driven by cancer, and progressive malignancy is a strong mortality predictor. Importantly, 85% of the patients were alive at 1 year, one-third were in remission/cured from cancer. (Outcomes of Transcatheter Aortic Valve Implantation in Oncology Patients With Severe Aortic Stenosis [TOP-AS]; NCT03181997).
Insights
Transcatheter aortic valve replacement (TAVR) in oncology patients shows similar short-term outcomes but higher long-term mortality, primarily driven by progressive malignancy. However, many patients achieve remission, highlighting TAVR as a viable option.
Area of Science:
- Cardiology
- Oncology
- Interventional Cardiology
Background:
- Oncology patients with severe aortic stenosis (AS) are frequently excluded from valve replacement procedures.
- Transcatheter aortic valve replacement (TAVR) presents a potential treatment avenue for this population.
Purpose of the Study:
- To evaluate the contemporary practice and outcomes of TAVR in patients with severe AS and active malignancy.
- To compare TAVR outcomes between oncology patients and a matched cohort without cancer.
Main Methods:
- A global registry (TOP-AS) collected data on 222 oncology patients undergoing TAVR.
- Outcomes were compared to 2,522 non-cancer patients, with propensity-score matching applied.
- Patient demographics, cancer types, stage at TAVR, and procedural complications were analyzed.
Main Results:
- Oncology patients (mean age 78.8 years) had diverse cancers (GI, prostate, breast, hematologic, lung), with 40% at Stage 4.
- Periprocedural complications and 30-day mortality were similar between groups.
- One-year mortality was higher in cancer patients (15% vs. 9%), with neoplasm driving deaths. Progressive malignancy (Stage III-IV) was a significant mortality predictor.
Conclusions:
- TAVR in oncology patients yields comparable short-term results but poorer long-term survival versus non-cancer patients.
- Cancer progression is a key determinant of mortality in this cohort.
- A significant proportion (one-third) of cancer patients achieved cancer remission within one year post-TAVR.
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