One thousand patients with symptomatic aortic valve disease and malignancy: Can they withstand aortic valve replacement?

Aortic valve disease is the third most common cardiovascular disease among the elderly. Once it becomes symptomatic, the short-term prognosis is poor. These patients often have comorbid conditions such as malignancies. The main question is to identify if such patients can undergo aortic valve replacement (AVR) which is the only way to improve prognosis. One thousand patients underwent valve replacement in a 7-year time span. A retrospective file study was performed to evaluate the presence of malignancies, other pre-operative comorbid conditions, severity of heart diseases, operative data and post-operative complications. Statistical analyses were performed using chi-square and Mann-Whitney U-test. Malignancies were found in 137 patients. With respect to comorbid conditions, there were no significant differences between cancer and non-cancer patients, except for a higher mean transvalvular gradient (P = 0.027) and less obesity (P = 0.033) or hyperlipidemia (P = 0.052). Post-operative results showed a trend of delirium cases in cancer patients (P = 0.071), and there was a borderline shorter length of hospital stay (P = 0.087). There were no significant differences in other post-operative complications or mortality, which was 5.8% for cancer patients and 4.5% for non-cancer patients (P = 0.704). Elderly patients with a history of malignancies can withstand major cardiac surgeries such as AVR. They did not exhibit comorbid conditions or major post-operative complications. Mortality was also comparable. If such patients have an acceptable cancer prognosis, they should not be denied the life-saving AVR. However, the decision to offer AVR should be made by a multidisciplinary team involving cardiologists, cardiac surgeons and oncologists. Once such decision is made, it should not be delayed.