Transcatheter aortic valve replacement after chest radiation: A propensity-matched analysis

Area of Science:

• Cardiology
• Oncology
• Radiology

Background:

• Chest radiation therapy (CRT) for thoracic cancers can lead to later valvular heart disease.
• Previous radiation exposure poses challenges for surgical interventions.
• Transcatheter aortic valve replacement (TAVR) offers an alternative for these patients, but outcomes data are limited.

Purpose of the Study:

• To evaluate the safety and effectiveness of TAVR in patients with a history of CRT.
• To compare TAVR outcomes in patients with and without prior CRT.

Main Methods:

• Retrospective study of 1341 TAVR patients (Sept 2012 - Nov 2018).
• 50 patients with prior CRT were propensity-matched 1:2 to 100 patients without CRT history.
• Analysis of 30-day adverse events and overall mortality using statistical models.

Main Results:

• No significant difference in overall mortality (HR 0.84) or 30-day mortality (HR 3.1) between groups.
• Similar 30-day readmission rates (HR 1.0).
• Higher rates of postprocedural respiratory failure (HR 3.63) and permanent pacemaker implantation (HR 2.84) in the CRT group.

Conclusions:

• TAVR is a safe and effective treatment for aortic valve stenosis in patients with prior CRT.
• Outcomes are comparable to the general TAVR population.
• Increased risk of respiratory failure and pacemaker implantation necessitates careful patient selection and monitoring.