Key result
Cancer history linked to ~31% lower short-term mortality after TAVR but worse long-term survival.
Why the study?
Research on the clinical efficacy and safety of TAVR in patients with cancer and severe aortic stenosis is limited and conclusions are controversial.
Does a history of cancer affect short-term and long-term mortality in patients undergoing transcatheter aortic valve replacement?
Meta-Analysis (n=195,658)
Does a history of cancer affect short-term and long-term mortality in patients undergoing transcatheter aortic valve replacement?
Odds Ratio: 0.69 (95% CI 0.61–0.77)
p-value: p=<0.001
Patients with cancer undergoing TAVR have lower short-term mortality and acceptable perioperative complications compared to those without cancer, though their long-term survival is worse, likely driven by the underlying malignancy.
Cancer history was associated with lower short-term but higher long-term TAVR mortality; leaves open whether it should influence patient selection.
Background: Owing to the minimally invasive nature of transcatheter aortic valve replacement (TAVR), TAVR seems to be preferred in patients with cancer; however, related research on the clinical efficacy and safety of TAVR in patients with cancer and severe aortic stenosis is limited, and conclusions are controversial. This study aimed to evaluate the clinical outcomes of patients with cancer who underwent TAVR. Method and results: We conducted a systematic review and meta-analysis to investigate the clinical outcomes in patients with and without cancer who underwent TAVR. We systematically reviewed and analyzed 15 studies (195,658 patients) published in PubMed and Cochrane Library databases between January 2022 and January 2023. The primary outcomes were short-term (in-hospital or 30-day) and long-term (≥12 months) mortality. The prevalence of current or previous cancer in the patients undergoing TAVR was 19.8 % (38,695 patients). Patients with cancer had a lower risk of short-term mortality (odds ratio [OR] 0.69, 95 % confidence interval [CI] 0.61-0.77, P < 0.001) but a higher risk of long-term mortality (OR 1.54, 95 % CI 1.35-1.76, P < 0.001) than those without cancer. Patients with cancer had a lower incidence of postprocedural stroke and acute kidney injury but a higher incidence of pacemaker implantation than patients without cancer. Conclusions: Patients with cancer undergoing TAVR have a good short-term prognosis and acceptable perioperative complications compared with patients without cancer. However, the long-term outcomes are contingent on cancer survival.
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Osawa et al. (2024) conducted a meta-analysis in Severe aortic stenosis (n=195,658). Current or previous cancer vs. No cancer was evaluated on Short-term (in-hospital or 30-day) mortality (OR 0.69, 95% CI 0.61-0.77, p=<0.001). Patients with cancer undergoing TAVR had a lower risk of short-term mortality (OR 0.69) but a higher risk of long-term mortality (OR 1.54) compared to those without cancer.
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