Impact of Cancer in Patients Undergoing Transcatheter Aortic Valve Replacement: A Single-Center Study

Alexander Lind; Matthias Totzeck; Amir A Mahabadi; Rolf A Jánosi; Mohamed El Gabry; Arjang Ruhparwar; Simone M Mrotzek; Lena Hinrichs; Merve Akdeniz; Tienush Rassaf; Raluca I Mincu

doi:10.1016/j.jaccao.2020.11.008

Impact of Cancer in Patients Undergoing Transcatheter Aortic Valve Replacement: A Single-Center Study

JACC CardioOncol. 2020 Dec 15;2(5):735-743. doi: 10.1016/j.jaccao.2020.11.008. eCollection 2020 Dec.

Affiliations

¹ Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
² Department of Cardiovascular und Thoracic Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.

Abstract

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: 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: 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: 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: 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.

Keywords: 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.