Favorable outcome of cancer patients undergoing transcatheter aortic valve replacement

• Published in: International journal of cardiology Vol. 315; pp. 86 - 89
• Main Authors: Biancari, Fausto, Dahlbacka, Sebastian, Juvonen, Tatu, Virtanen, Marko P.O., Maaranen, Pasi, Jaakkola, Jussi, Laakso, Teemu, Niemelä, Matti, Tauriainen, Tuomas, Vento, Antti, Husso, Annastiina, Savontaus, Mikko, Laine, Mika, Mäkikallio, Timo, Raivio, Peter, Eskola, Markku, Rosato, Stefano, Anttila, Vesa, Airaksinen, Juhani, Valtola, Antti
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.09.2020
• Subjects: Aortic Valve - surgery; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - surgery; Cancer; Humans; Malignancy; Neoplasms - surgery; Registries; Retrospective Studies; Risk Factors; TAVI; TAVR; Transcatheter Aortic Valve Replacement; Treatment Outcome; Malignancy; Transcatheter aortic valve replacement; TAVR; TAVI; Cancer
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2020.03.038

The aim of this study was to assess the outcome of transcatheter aortic valve replacement (TAVR) in patients with cancer. This is a retrospective study from the nationwide FinnValve registry on 2130 consecutive patients who underwent TAVR for severe AS from January 2008 to October 2017. In this cohort, 417 patients (19.6%) had history of cancer and 113 (5.3%) had an active malignancy at the time of TAVR. Patients with any malignancy had similar late mortality than patients without any malignancy (at 7 years, 65.1% vs. 59.3%, adjusted HR 1.105, 95%CI 0.892–1.369). At 7 years, cancer-related mortality was 22.5% among patients with preoperative cancer, and 11.0% in those without preoperative cancer (p < 0.0001). Among cancer patients, 18 died of the same disease (at 7 years, mortality 12.5%). Active malignancy was not associated with increased risk of all-cause mortality (adjusted HR 1.100, 95%CI 0.757–1.599). However, patients with blood malignancies had a significantly increased risk of mortality (at 4-year, 53.5% vs. 35.4%, adjusted HR 2.029, 95%CI 1.328–3.098). This analysis showed that, when properly selected by the heart team and oncologists, most cancer patients undergoing TAVR can achieve a good survival and eventually die of other diseases. Blood malignancies seem to carry a poor prognosis in these patients. Clinical trial registration:ClinicalTrials.gov Identifier: NCT03385915; https://clinicaltrials.gov/ct2/show/NCT03385915. •It is controversial whether cancer patients undergoing TAVR have worse prognosis.•This nationwide registry showed that 20% of patients scheduled for TAVR had cancer.•Provided appropriate selection, cancer patients have favorable survival after TAVR.