Key result
Active cancer in TAVR patients had similar 30-day survival to controls (94.3% vs 93.3%, p=0.161) but a higher risk of 10-year mortality (HR 1.47; 95% CI 1.16-1.87).
Why the study?
The use of TAVR in cancer survivors and patients with active cancer is expanding, suggesting a need to adjust indications and risk assessment pre-TAVR.
Does the presence of active or stable cancer impact peri-procedural complications and survival in patients undergoing TAVR?
Cohort (n=1,088)
No
Does the presence of active or stable cancer impact peri-procedural complications and survival in patients undergoing TAVR?
Answers are grounded in this paper and cite their sources.
Supports TAVR in active cancer patients; leaves open whether cancer-specific strategies mitigate long-term mortality.
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.
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Lind et al. (2020) conducted a cohort in Patients undergoing transcatheter aortic valve replacement (TAVR) (n=1,088). Active or stable cancer vs. Patients without cancer (controls) was evaluated on Peri-procedural complications and 30-day survival (p=0.161). Active cancer in TAVR patients had similar 30-day survival to controls (94.3% vs 93.3%, p=0.161) but a higher risk of 10-year mortality (HR 1.47; 95% CI 1.16-1.87).
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