This meta-analysis tells us that patients with active malignancies and severe aortic stenosis have a good evolution after transcatheter aortic valve replacement (TAVR), except for a higher rate of pacemaker implantation in the general population.
These patients must not be limited to respite care only, at least as far as aortic stenosis is concerned.
Short-term results after TAVR have the same efficacy and safety that in cancer-free patients. In the long term, malignancy stage does make a difference.
All initial and paradigmatic studies on TAVR systematically excluded patients with any type of malignancy.
Advanced cancer was defined as a stage greater than T2 for the primary tumor, N1 for lymph nodes, and/or M1 for metastases. Researchers also considered whether the malignancy was refractory, relapsing, or recurrent. Mortality 1 year after TAVR was more than twofold higher among patients with advanced disease stages compared with patients with limited disease stages.
These huge differences in survival at 1 year should be taken into account when making decisions about conducting TAVR on a given patient, but they do not mean that we should routinely exclude the procedure as an alternative for all cancer patients.
Recently published in Open Heart, this meta-analysis pooled 3 studies, with a total of 5162 patients who underwent TAVR. Of these, 7.1% had an active cancer. The most common cancer types were gastrointestinal (22.6%), prostate (18.4%), hematological (17.1%), and breast (14.4%).
After 30 days of follow-up, all-cause mortality was similar among patients with and without active cancer (risk ratio [RR]: 0.92; 95% confidence interval [CI]: 0.53-1.59). These differences became apparent only at 1 year and were driven by advanced-stage patients.
The only safety endpoint that was higher among patients with cancer was the need for a permanent pacemaker (RR: 1.29; 95% CI: 1.06-1.58). Frequently used drugs such as methotrexate, 5-fluorouracil, and cisplatin are associated with conduction disorders and might explain the higher pacemaker implantation rates.
Original Title: Transcatheter aortic valve replacement in patients with severe aortic stenosis and active cancer: a systematic review and meta-analysis.
Reference: Bendary A et al. Open Heart. 2020;7:e001131.
We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.