Outcomes of patients with active cancer undergoing transcatheter aortic valve replacement

Antonin Trimaille; Kensuke Matsushita; Benjamin Marchandot; Adrien Carmona; Sebastien Hess; Antje Reydel; Loic Faucher; Amandine Granier; Trung Anh Mai; Bamba Diop; Patrick Ohlmann; Laurence Jesel; Olivier Morel

doi:10.1016/j.acvd.2023.08.001

Outcomes of patients with active cancer undergoing transcatheter aortic valve replacement

Arch Cardiovasc Dis. 2023 Sep 12:S1875-2136(23)00165-1. doi: 10.1016/j.acvd.2023.08.001. Online ahead of print.

Affiliations

¹ Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France; Inserm (French National Institute of Health and Medical Research), FMTS, Regenerative Nanomedicine, UMR 1260, 67000 Strasbourg, France.
² Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France.
³ Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France; Inserm (French National Institute of Health and Medical Research), FMTS, Regenerative Nanomedicine, UMR 1260, 67000 Strasbourg, France. Electronic address: olivier.morel@chru-strasbourg.fr.

PMID: 37758593
DOI: 10.1016/j.acvd.2023.08.001

Abstract

Background: Cardiovascular disease and cancer are the two leading causes of mortality worldwide, and their association presents a therapeutic challenge. Current data regarding the prognosis of active cancer in patients undergoing transcatheter aortic valve replacement are conflicting.

Aim: To determine the impact and prognosis of active cancer in transcatheter aortic valve replacement.

Methods: All consecutive patients with severe aortic stenosis treated by transcatheter aortic valve replacement between February 2010 and May 2019 were enrolled in a prospective study. The cohort was divided according to the presence or absence of active cancer at baseline. The primary endpoint was all-cause mortality 1 year after the procedure.

Results: A total of 1,125 patients were enrolled: 1,037 (92.2%) without and 88 (7.8%) with active cancer. The most frequent cancers were haematological (36.4%), breast (14.8%) and prostate (14.8%), with 79.5% of patients receiving curative treatment and 17.0% receiving palliative treatment. The 1-year mortality rate was higher in patients with active cancer (27.3% vs. 13.9%; P<0.01), mainly driven by non-cardiovascular causes. An increased cardiovascular mortality rate at 2 years was seen in patients with active cancer (27.5% vs. 15.0%; P=0.03) compared with a similar rate at 1-year follow-up. Active cancer was a strong predictor of 1-year all-cause mortality (hazard ratio 2.46, 95% confidence interval 1.19-4.68; P=0.02). Major/life-threatening bleeding events at 1 year were more frequent in patients with active cancer (P=0.02).

Conclusions: Among patients who undergo transcatheter aortic valve replacement, 1-year all-cause mortality is higher in those with active cancer. We also observed a trend towards increased long-term bleeding events in case of active cancer.

Keywords: Aortic stenosis; Cancer; Heart team; Oncology; Transcatheter aortic valve replacement.