Key result
Prior chest radiation therapy was not associated with a significant difference in all-cause death or stroke at 2 years after TAVR compared to no prior radiation (30.7% vs 27.0%; HR 1.08, P=0.75).
Why the study?
Patients with prior chest radiation therapy perform poorly with surgical aortic valve replacement, but clinical outcomes after TAVR in this population have not been well studied.
Does TAVR yield similar clinical outcomes in severe symptomatic aortic stenosis patients with prior chest radiation therapy compared to those without?
Cohort (n=3,987)
Does TAVR yield similar clinical outcomes in severe symptomatic aortic stenosis patients with prior chest radiation therapy compared to those without?
TAVR is a viable alternative for severe symptomatic aortic stenosis in patients with prior chest radiation therapy, showing comparable 2-year rates of death and stroke to those without prior radiation.
Answers are grounded in this paper and cite their sources.
TAVR may be considered for severe AS with prior cXRT; leaves open need for randomized trials versus SAVR.
OBJECTIVES: The purpose of this study is to investigate the viability of transcatheter aortic valve replacement (TAVR) for severe symptomatic aortic stenosis (AS) in patients with prior chest radiation therapy (cXRT). BACKGROUND: Since patients with prior cXRT perform poorly with surgical aortic valve replacement, TAVR can be a viable alternative. However, clinical outcomes after TAVR in this patient population have not been well studied. METHODS: From the pooled registry of the placement of aortic transcatheter valves II trial, we identified patients with and without prior cXRT who underwent TAVR (n = 64 and 3923, respectively). The primary outcome was a composite of all-cause death and any stroke at 2 years. Time to event analyses were shown as Kaplan-Meier event rates and compared by log-rank testing. Hazard ratios (HRs) were estimated and compared by Cox proportional hazards regression model. RESULTS: There was no significant difference in the primary outcome between the patients with and without prior cXRT (30.7% vs. 27.0%; p = 0.75; HR, 1.08; 95% confidence interval, 0.66-1.77). Rates of myocardial infarction, vascular complications, acute kidney injury, or new pacemaker implant after TAVR were not statistically different between the two groups. The rate of immediate reintervention with a second valve for aortic regurgitation after TAVR was higher among the patients with prior cXRT. However, no further difference was observed during 2 years follow-up after discharge from the index-procedure hospitalization. CONCLUSIONS: TAVR is a viable alternative for severe symptomatic AS in patients who had cXRT in the past.
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Mohanty et al. (2022) conducted a cohort in severe symptomatic aortic stenosis (AS) (n=3,987). Prior chest radiation therapy (cXRT) vs. No prior chest radiation therapy was evaluated on composite of all-cause death and any stroke at 2 years (HR 1.08, 95% CI 0.66-1.77, p=0.75). Prior chest radiation therapy was not associated with a significant difference in all-cause death or stroke at 2 years after TAVR compared to no prior radiation (30.7% vs 27.0%; HR 1.08, P=0.75).
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