SOLACI | Latin American Society of Interventional Cardiology

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.

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.

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