Impact of Cancer in Patients Undergoing Transcatheter Aortic Valve Replacement: A Single-Center Study.
AC, active cancer
NYHA, New York Heart Association
SC, stable cancer
STS, Society of Thoracic Surgeons
TAVR, transcatheter aortic valve replacement
aortic stenosis
cancer
guidelines
outcomes
risk prediction
transcatheter aortic valve replacement
treatment planning
valvular disease
Journal
JACC. CardioOncology
ISSN: 2666-0873
Titre abrégé: JACC CardioOncol
Pays: United States
ID NLM: 101761697
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
03
02
2020
accepted:
03
11
2020
entrez:
16
8
2021
pubmed:
17
8
2021
medline:
17
8
2021
Statut:
epublish
Résumé
The use of transcatheter aortic valve replacement (TAVR) in cancer survivors and patients with active cancer (AC) in cancer survivors and patients with active cancer (AC) is expanding, suggesting a need to adjust the indications and risk assessment pre-TAVR. The purpose of this study was to determine the impact of cancer on peri-procedural complications and survival in a long-term, single-center cohort of patients treated with TAVR. Patients treated with TAVR between January 2006 and December 2018 were grouped as follows: controls (patients without cancer), stable cancer (SC), and AC. The primary endpoints were peri-procedural complications and 30-day survival. A secondary endpoint was 10-year survival. A total of 1,088 patients (age 81 ± 5 years, 46.6% men) treated with transfemoral TAVR were selected: 839 controls, 196 SC, and 53 AC. Predominant malignancies were breast, gastrointestinal, and prostate cancer. No differences were observed between patients with cancer and controls regarding peri-procedural complications. Patients with AC had similar 30-day survival compared with controls and SC (94.3% vs. 93.3% vs. 96.9%, p = 0.161), but as expected, reduced 10-year survival. AC was associated with a 1.47 (95% CI 1.16 to 1.87) fold increased risk of all-cause 10-year mortality in multivariable adjusted models. TAVR should be performed in patients with cancer when indicated, considering that patients with cancer have similar periprocedural complications and short-term survival compared with control patients. However, patients with AC have worse 10-year survival. Future studies are needed to define cancer-specific determinants of worse long-term survival.
Sections du résumé
BACKGROUND
BACKGROUND
The use of transcatheter aortic valve replacement (TAVR) in cancer survivors and patients with active cancer (AC) in cancer survivors and patients with active cancer (AC) is expanding, suggesting a need to adjust the indications and risk assessment pre-TAVR.
OBJECTIVES
OBJECTIVE
The purpose of this study was to determine the impact of cancer on peri-procedural complications and survival in a long-term, single-center cohort of patients treated with TAVR.
METHODS
METHODS
Patients treated with TAVR between January 2006 and December 2018 were grouped as follows: controls (patients without cancer), stable cancer (SC), and AC. The primary endpoints were peri-procedural complications and 30-day survival. A secondary endpoint was 10-year survival.
RESULTS
RESULTS
A total of 1,088 patients (age 81 ± 5 years, 46.6% men) treated with transfemoral TAVR were selected: 839 controls, 196 SC, and 53 AC. Predominant malignancies were breast, gastrointestinal, and prostate cancer. No differences were observed between patients with cancer and controls regarding peri-procedural complications. Patients with AC had similar 30-day survival compared with controls and SC (94.3% vs. 93.3% vs. 96.9%, p = 0.161), but as expected, reduced 10-year survival. AC was associated with a 1.47 (95% CI 1.16 to 1.87) fold increased risk of all-cause 10-year mortality in multivariable adjusted models.
CONCLUSIONS
CONCLUSIONS
TAVR should be performed in patients with cancer when indicated, considering that patients with cancer have similar periprocedural complications and short-term survival compared with control patients. However, patients with AC have worse 10-year survival. Future studies are needed to define cancer-specific determinants of worse long-term survival.
Identifiants
pubmed: 34396288
doi: 10.1016/j.jaccao.2020.11.008
pii: S2666-0873(20)30289-1
pmc: PMC8352296
doi:
Types de publication
Journal Article
Langues
eng
Pagination
735-743Informations de copyright
© 2020 The Authors.
Déclaration de conflit d'intérêts
Dr. Mincu was supported by the European Society of Cardiology through a Research Grant (R-2016–013). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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