Comparison of Results of Transcatheter Aortic Valve Implantation in Patients with Versus without Active Cancer

• Published in: The American journal of cardiology Vol. 118; no. 4; pp. 572 - 577
• Main Authors: Watanabe, Yusuke, MD, Kozuma, Ken, MD, PhD, Hioki, Hirofumi, MD, Kawashima, Hideyuki, MD, Nara, Yugo, MD, Kataoka, Akihisa, MD, PhD, Shirai, Shinichi, MD, Tada, Norio, MD, Araki, Motoharu, MD, Takagi, Kensuke, MD, Yamanaka, Futoshi, MD, Yamamoto, Masanori, MD, PhD, Hayashida, Kentaro, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.08.2016; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Aortic Valve Stenosis - epidemiology; Aortic Valve Stenosis - surgery; Body mass index; Cancer; Cardiovascular; Case-Control Studies; Chronic obstructive pulmonary disease; Comorbidity; Confidence intervals; Female; Heart; Heart surgery; Hospitals; Humans; Japan - epidemiology; Kaplan-Meier Estimate; Kidneys; Male; Metastasis; Mortality; Multivariate Analysis; Neoplasm Metastasis; Neoplasms - epidemiology; Neoplasms - pathology; Postoperative Complications - epidemiology; Postoperative Hemorrhage - epidemiology; Proportional Hazards Models; Prostheses; Registries; Studies; Success; Survival Rate; Transcatheter Aortic Valve Replacement; Treatment Outcome; Variables; Japan; Transcatheter aortic valve implantation; metastasis; cancer
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2016.05.052

Abstract The aim of this study was to evaluate post-procedural and midterm outcomes of transcatheter aortic valve implantation (TAVI) in patients with aortic stenosis (AS) and active cancer. Between October 2013 and August 2015, a total of 749 patients undergoing TAVI using the Edwards Sapien XT prosthesis (Edwards Lifesciences, Irvine, California, USA) were prospectively included in the OCEAN-TAVI registry from eight Japanese centers. A total of 47 patients (44.7% men; median age 83 years) had active cancer. The transfemoral approach was implemented in 85.1% of patients in the cancer group and 78.1% in the non-cancer group (p=0.22). The occurrence of major vascular complication (4.3% vs. 7.5%, p=0.24), life threatening bleeding (2.1% vs. 7.1%, p=0.15), and major bleeding (8.5% vs. 13%, p=0.38) was similar between the cancer and non-cancer groups. No significant differences were observed regarding device success (100% vs. 96.2%, p=0.17) or 30-day survival (95.7% vs. 97.3%, p=0.38). No difference in midterm survival was found between the cancer patients and non-cancer patients (Log-rank, p=0.42), regardless of advanced or limited cancer (Log-rank, p=0.68). In a multivariable Cox proportional hazard regression analysis, cancer metastasis was one of the most significant predictors of late mortality (hazard ratio: 4.73; 95% confidence interval: 1.12 to 20.0; p=0.035). In conclusion, cancer patients with severe AS who underwent TAVI had similar acute outcomes and midterm survival rates compared to non-cancer patients. Cancer metastasis was associated with increased mortality after TAVI.