Long-term outcomes of TAVI in patients with cancer: insights into early and late mortality trends

Introduction With advances in cancer therapy and improved survival, the coexistence of severe aortic stenosis (AS) and cancer has become increasingly common. Cancer patients undergoing transcatheter aortic valve implantation (TAVI) present unique challenges due to frailty, comorbidities, and the malignancy-cardiovascular disease interplay. While TAVI is a viable alternative to surgical aortic valve replacement (SAVR) in high-risk populations, long-term outcomes in cancer patients remain understudied. This study explores TAVI trends and survival in patients with active, past, and no cancer history. Methods We retrospectively analyzed data from 1,511 patients who underwent TAVI between January 2013 and December 2022 at our hospital, with follow-up until February 2024. Patients were stratified into three groups: no cancer history (n=1,336), past cancer (n=123), and active cancer (n=52). Active cancer was defined as a diagnosis/treatment within 12 months of TAVI, metastatic disease, or recurrent cancer. Demographics, procedural characteristics, and outcomes were compared across groups. Kaplan-Meier analysis assessed all-cause mortality. Results Patients with active cancer were younger (mean age 77.5 ± 8.7 years) compared to those with past cancer (80.2 ± 7.9) and no cancer history (80.4 ± 7.7; p=0.033). There were no significant differences between the groups in the percentage of female patients (50.7%, 48.0%, 44.2%, respectively; p = 0.565) or in the prevalence of cardiovascular risk factors and comorbidities, such as hypertension, diabetes mellitus, peripheral vascular disease, past stroke, and atrial fibrillation. Procedural characteristics, including femoral access and general anesthesia use, were similar across groups. Active cancer patients had a higher estimated glomerular filtration rate (eGFR) and lower rates of prior percutaneous coronary interventions (p<0.05). Hematologic and breast cancers were the most common malignancies in the active cancer cohort, with 36% of solid tumors classified as stage IV. The median follow-up time was 1248 days (IQR 729–1914). Short-term (30-day) mortality was comparable among groups. However, long-term mortality was significantly higher in the active cancer group (HR 1.85, CI 1.13–3.03, p=0.013. Figure 1), driven primarily by cancer-related causes. Subgroup analysis demonstrated that patients with gastrointestinal cancer had the poorest outcomes, whereas those with breast cancer exhibited the most favorable prognosis (figure 2). Conclusions TAVI is a feasible and safe option for cancer patients with severe AS, offering comparable short-term outcomes to non-cancer patients. However, long-term survival remains poorer in patients with active malignancy, emphasizing the importance of individualized, multidisciplinary decision-making. Future efforts should focus on optimizing patient selection, procedural timing, and post-TAVI cancer care to improve outcomes in this growing patient population.Kaplan-Meier survival analysis survival analysis by cancer type