Transcatheter aortic valve replacement in patients with cancer: A 10-year registry analysis of early and long-term mortality outcomes

BACKGROUND: Patients with cancer increasingly undergo transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS), yet the long-term outcomes and prognostic implications of active malignancy remain uncertain. We evaluated short- and long-term mortality following TAVR in patients with active or prior cancer using a large single-center registry. METHODS: We conducted a retrospective cohort study of 1511 patients who underwent TAVR at a tertiary center between 2013 and 2022, categorized by cancer status: no cancer, past cancer, or active cancer (defined as diagnosis within 12 months, metastatic disease, or ongoing oncologic treatment). Mortality outcomes were assessed using Kaplan-Meier curves and Cox proportional hazards models, with multivariable adjustment for clinical risk factors. RESULTS: Among 1511 patients, 1336 (88.4 %) had no cancer, 123 (8.1 %) had past cancer and 52 (3.5 %) had active cancer. Patients with active cancer had similar 30-day (HR 0.82; 95 % CI 0.11-6.01; p = 0.845) and 1-year mortality (HR 1.73; 95 % CI 0.80-3.72; p = 0.160) compared with those without cancer. At 3 years, active cancer was independently associated with increased mortality (HR 2.04; 95 % CI 1.24-3.34; p = 0.004), with the highest risk seen in gastrointestinal and hematologic malignancies. Patients with breast or prostate cancer had more favorable outcomes. CONCLUSIONS: TAVR in patients with active cancer is associated with comparable short- and mid-term outcomes relative to those without patients, supporting its feasibility in selected individuals. Long-term mortality varies by cancer type, highlighting the need for multidisciplinary, individualized decision-making when evaluating procedural candidacy.