Why the study?
Clinical outcomes for TAVR in cancer survivors with prior chest radiation therapy and symptomatic aortic-valve stenosis have not been adequately assessed in major clinical trials, leading to conflicting results.
Does prior chest radiation therapy worsen mortality and safety outcomes in cancer survivors undergoing TAVR for severe aortic stenosis?
Does prior chest radiation therapy worsen mortality and safety outcomes in cancer survivors undergoing TAVR for severe aortic stenosis?
TAVR has similar mortality and efficacy in cancer survivors with prior chest radiation therapy compared to those without, though they face a higher risk of post-procedural worsening heart failure.
Answers are grounded in this paper and cite their sources.
TAVR mortality similar with or without prior radiation but CHF worsening higher; extends observational safety data while leaving HF optimization open.
Clinical outcomes for TAVR in cancer survivors with prior chest radiation therapy (C-XRT) who develop symptomatic aortic-valve stenosis are not adequately assessed in major clinical trials leading to conflicting results. Hence, we conducted this meta-analysis to evaluate the, safety, efficacy, and mortality outcomes of cancer survivors with prior C-XRT undergoing TAVR. MEDLINE and Scopus were searched up to March 2024. Observational studies and randomized controlled trials comparing severe aortic stenosis patients with and without prior C-XRT undergoing TAVR with at least one outcome of interest were shortlisted. Data were analyzed using random-effects model to derive weighted mean differences, and risk ratios with 95% confidence intervals. Six studies with 6,191 patients (278 C-XRT and 5,913 no-C-XRT) were included. All-cause mortality at 30-day (RR 1.63, p = 0.12) and 1-year interval (RR 1.59, p = 0.08) showed no significant differences with prior C-XRT versus no-C-XRT. Worsening CHF was the only post-procedural safety outcome significantly higher in patients with prior C-XRT (RR 1.98, p = 0.0004) versus no- C-XRT. The efficacy end-points i.e., improvement in LVEF (MD 1.24; -0.50, 2.98), and aortic valve gradient (MD -0.63; -1.32, 0.05) were not significantly different. TAVR has similar all-cause mortality, efficacy and safety (except CHF worsening) among cancer survivors with and without a prior history of C-XRT.
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Yasmin et al. (2024) studied this question.
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