Courtesy of Dr. Carlos Fava.
Oncology patients have been excluded from all studies, but many of them have a life expectancy of over a year or two, and aortic stenosis can pose a problem as regards their treatment.
This study analyzed 2744 patients who underwent TAVR. Among them, 222 presented cancer (8.1%).
Patients with cancer were younger, more fragile, had lower serum albumin levels, experienced less cardiovascular events, and had lower Society of Thoracic Surgeons [STS] mortality scores.
The most frequent cancer type was gastrointestinal cancer, followed by prostate, breast, hematologic, and lung cancers.
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Transfemoral access was more used in patients without cancer. There were no differences between cohorts as regards procedure-related complications, except for higher bleeding rates among patients with cancer.
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 related to the progression of cancer. This was, in turn, strongly linked to stage III-IV patients (hazard ratio: 2.37; 95% confidence interval: 1.74 to 3.23; p < 0.001), but not to stage I-II patients.
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Among cancer patients who survived one year, one third were in remission/cured.
Conclusion
Among cancer patients, TAVR is associated with similar short-term but worse long-term prognosis compared with patients without cancer. In patients with this disease, mortality is higher due to it and to progressive malignancy, which is a strong predictor. It should be noted that 85% of the patients survived one year and one third were in remission/cured from cancer.
Courtesy of Dr. Carlos Fava.
Original title: Transcatheter Aortic Valve Replacement in Oncology Patients with Severe Aortic Stenosis.
Reference: Uri Landes et al. J Am Coll Cardiol Intv 2019;12:78-86
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