Miha Mrak1, Jana Ambrožič1, Špela Mušič2, Simon Terseglav1, Bojan Kontestabile2, Nikola Lakič3, Matjaž Bunc4,5. 1. Clinical Department of Cardiology, University Medical Centre Ljubljana, Zaloška 4, 1000, Ljubljana, Slovenia. 2. Clinical Department for anesthesiology and intensive therapy, University Medical Centre Ljubljana, Zaloška 4, 1000, Ljubljana, Slovenia. 3. Clinical Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Zaloška 4, 1000, Ljubljana, Slovenia. 4. Clinical Department of Cardiology, University Medical Centre Ljubljana, Zaloška 4, 1000, Ljubljana, Slovenia. mbuncek@yahoo.com. 5. Institute for Pathophysiology, School of Medicine, Zaloška c. 7, 1000, Ljubljana, Slovenia. mbuncek@yahoo.com.
Abstract
BACKGROUND: Aortic stenosis is a progressive disease. Symptomatic aortic stenosis has a poor prognosis, which is frequently worse than that of a malignant disease. Cancer patients with severe aortic stenosis may be denied for optimal oncologic treatment because of high operative risk and for aortic valve replacement because of the significant comorbidity itself. In patients treated with medical therapy alone, 1-year-mortality exceeds 50 %. CASE REPORT: A 71-year-old woman with well-differentiated, surgically treated, ovarian carcinoma and two relapses treated with chemo- and radiotherapy presented with symptomatic severe aortic stenosis (aortic valve area 0.6 cm(2), mean gradient 60 mmHg). The tumor was in stagnation. She was rejected for surgical valve replacement. We implanted a 29 mm CoreValve aortic prosthesis via transfemoral approach. After the procedure haemodynamic variables remain stable, patient's exertional capacity is excellent. CONCLUSION: Aortic valve replacement improves survival of cancer patients with symptomatic aortic stenosis. Transcatheter aortic valve replacement (TAVI) is a treatment option in inoperable patients and patients at high surgical risk. Symptoms should not be confused for the progression of the malignant disease. In patient selection emphasis should be made on their frailty and futility. Eligible patients must have a life expectancy of at least 1 year. Final decision has to be made by a multidisciplinary heart team. TAVI can reduce treatment risk and facilitate the oncologic treatment.
BACKGROUND:Aortic stenosis is a progressive disease. Symptomatic aortic stenosis has a poor prognosis, which is frequently worse than that of a malignant disease. Cancerpatients with severe aortic stenosis may be denied for optimal oncologic treatment because of high operative risk and for aortic valve replacement because of the significant comorbidity itself. In patients treated with medical therapy alone, 1-year-mortality exceeds 50 %. CASE REPORT: A 71-year-old woman with well-differentiated, surgically treated, ovarian carcinoma and two relapses treated with chemo- and radiotherapy presented with symptomatic severe aortic stenosis (aortic valve area 0.6 cm(2), mean gradient 60 mmHg). The tumor was in stagnation. She was rejected for surgical valve replacement. We implanted a 29 mm CoreValve aortic prosthesis via transfemoral approach. After the procedure haemodynamic variables remain stable, patient's exertional capacity is excellent. CONCLUSION: Aortic valve replacement improves survival of cancerpatients with symptomatic aortic stenosis. Transcatheter aortic valve replacement (TAVI) is a treatment option in inoperable patients and patients at high surgical risk. Symptoms should not be confused for the progression of the malignant disease. In patient selection emphasis should be made on their frailty and futility. Eligible patients must have a life expectancy of at least 1 year. Final decision has to be made by a multidisciplinary heart team. TAVI can reduce treatment risk and facilitate the oncologic treatment.
Authors: Samir Kapadia; William J Stewart; William N Anderson; Vasilis Babaliaros; Ted Feldman; David J Cohen; Pamela S Douglas; Raj R Makkar; Lars G Svensson; John G Webb; S Chiu Wong; David L Brown; D Craig Miller; Jeffrey W Moses; Craig R Smith; Martin B Leon; E Murat Tuzcu Journal: JACC Cardiovasc Interv Date: 2015-02 Impact factor: 11.195
Authors: Juan Carlos Plana; Maurizio Galderisi; Ana Barac; Michael S Ewer; Bonnie Ky; Marielle Scherrer-Crosbie; Javier Ganame; Igal A Sebag; Deborah A Agler; Luigi P Badano; Jose Banchs; Daniela Cardinale; Joseph Carver; Manuel Cerqueira; Jeanne M DeCara; Thor Edvardsen; Scott D Flamm; Thomas Force; Brian P Griffin; Guy Jerusalem; Jennifer E Liu; Andreia Magalhães; Thomas Marwick; Liza Y Sanchez; Rosa Sicari; Hector R Villarraga; Patrizio Lancellotti Journal: Eur Heart J Cardiovasc Imaging Date: 2014-10 Impact factor: 6.875
Authors: Samir R Kapadia; Martin B Leon; Raj R Makkar; E Murat Tuzcu; Lars G Svensson; Susheel Kodali; John G Webb; Michael J Mack; Pamela S Douglas; Vinod H Thourani; Vasilis C Babaliaros; Howard C Herrmann; Wilson Y Szeto; Augusto D Pichard; Mathew R Williams; Gregory P Fontana; D Craig Miller; William N Anderson; Jodi J Akin; Michael J Davidson; Craig R Smith Journal: Lancet Date: 2015-03-15 Impact factor: 79.321
Authors: Lars G Svensson; Murat Tuzcu; Samir Kapadia; Eugene H Blackstone; Eric E Roselli; A Marc Gillinov; Joseph F Sabik; Bruce W Lytle Journal: J Thorac Cardiovasc Surg Date: 2013-03 Impact factor: 5.209
Authors: Pompilio Faggiano; Silvia Frattini; Valentina Zilioli; Andrea Rossi; Stefano Nistri; Frank L Dini; Roberto Lorusso; Cesare Tomasi; Livio Dei Cas Journal: Int J Cardiol Date: 2011-03-03 Impact factor: 4.164
Authors: Serban Mihai Balanescu; Dinu Valentin Balanescu; Teodora Donisan; Eric H Yang; Nicolas Palaskas; Juan Lopez-Mattei; Saamir Hassan; Peter Kim; Mehmet Cilingiroglu; Konstantinos Marmagkiolis; Biswajit Kar; Cezar Iliescu Journal: Curr Cardiol Rep Date: 2019-07-08 Impact factor: 2.931