Key result
TAVR shows similar short-term mortality in patients with or without prior chest radiation.
Why the study?
Patients with prior chest or mediastinal radiation are high risk for surgical AVR, but this population was underrepresented in prior TAVR trials.
Does TAVR have similar mortality and complication rates in patients with versus without a history of prior chest or mediastinal radiation?
Meta-Analysis (n=6,358)
Does TAVR have similar mortality and complication rates in patients with versus without a history of prior chest or mediastinal radiation?
Effect estimate: OR 1.63 (95% CI 0.89-2.98)
TAVR is a safe and viable option for patients with prior chest radiation, showing similar short- and mid-term mortality compared to those without radiation, though with increased early risks of heart failure exacerbation and valve reintervention.
Supports TAVR consideration after chest radiation; leaves open need for randomized data on complications.
BACKGROUND: Patients with prior history of chest or mediastinal radiation are deemed high risk for surgical AVR. Transcatheter aortic valve replacement (TAVR) has emerged as a promising alternative for these patients, however, this patient population was underrepresented in prior TAVR trials. AIMS: To compare the outcomes of TAVR in patients with versus without a history of prior chest or mediastinal radiation. METHODS: This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic search of electronic databases was conducted up to September 2023. We compared early and late mortality as well as complications. A meta-analysis was conducted with the use of a random effects model. The I-square statistic was used to assess heterogeneity. RESULTS: Seven studies comprising 6358 patients were included in this meta-analysis. Patients undergoing TAVR in the radiation group had a higher risk for heart failure exacerbation (OR: 2.06; 95% CI: 1.18-3.59) and aortic valve reintervention (OR: 5.68; 95% CI: 1.83-17.67) in the early postoperative period compared to the nonradiation group. Analysis revealed similar short-term (in-hospital or 30-day) all-cause-mortality (OR: 1.63; 95% CI: 0.89-2.98) between the two groups. Other perioperative complications including myocardial infarction (MI), stroke, pacemaker insertion requirement, major bleeding as well as access-related complications were not significantly different between the two groups. TAVR in the radiation group was not associated with increased all-cause mortality compared to the nonradiation group (OR: 1.40; 95% CI: 0.93-2.11) after a mean follow-up of 17.6 months. Other endpoints including MI, stroke, need for pacemaker insertion, heart failure readmission rate, and need for aortic valve reintervention were similar in the mid-term follow-up between the two groups. CONCLUSION: TAVR in patients with a history of prior chest or mediastinal radiation was associated with similar short-term and mid-term mortality compared to patients without radiation. The history of chest or mediastinal radiation was associated with more frequent heart failure hospitalizations and aortic valve reintervention in the postoperative period. No difference was found in mid-term complications. Future studies are warranted to validate our findings.
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Tzoumas et al. (2025) conducted a meta-analysis in Aortic valve disease requiring TAVR (n=6,358). TAVR in patients with prior chest or mediastinal radiation vs. TAVR in patients without prior chest or mediastinal radiation was evaluated on Short-term (in-hospital or 30-day) all-cause mortality (OR 1.63, 95% CI 0.89-2.98). TAVR in patients with prior chest radiation was associated with similar short-term all-cause mortality (OR 1.63; 95% CI 0.89-2.98) compared to patients without prior radiation.
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