Uri Landes1, Zaza Iakobishvili1, Daniella Vronsky2, Oren Zusman1, Alon Barsheshet1, Ronen Jaffe3, Ayman Jubran3, Sung-Han Yoon4, Raj R Makkar4, Maurizio Taramasso5, Marco Russo5, Francesco Maisano5, Jan-Malte Sinning6, Jasmin Shamekhi6, Luigi Biasco7, Giovanni Pedrazzini7, Marco Moccetti7, Azeem Latib8, Matteo Pagnesi8, Antonio Colombo8, Corrado Tamburino9, Paolo D' Arrigo9, Stephan Windecker10, Thomas Pilgrim10, Didier Tchetche11, Chiara De Biase11, Mayra Guerrero12, Omer Iftikhar12, Johan Bosmans13, Edo Bedzra14, Danny Dvir14, Darren Mylotte15, Horst Sievert16, Yusuke Watanabe17, Lars Søndergaard18, Hanna Dagnegård18, Pablo Codner1, Susheel Kodali19, Martin Leon19, Ran Kornowski20. 1. Cardiology Department, Rabin Medical Center, Petah Tikva, Israel; Cardiology Department, Carmel Medical Center, Haifa, Israel. 2. Cardiology Department, Rabin Medical Center, Petah Tikva, Israel. 3. Cardiology Division, Cedars-Sinai Medical Center, Los Angeles, California. 4. Cardiology Department, University Hospital of Zurich, Zurich, Switzerland. 5. Cardiology Department, University Hospital Bonn, Bonn, Germany. 6. Fondazione Cardiocentro Ticino, Lugano, Switzerland. 7. San Raffaele Scientific Institute, Milan, Italy. 8. Cardiology Department, Ferrarotto Medical Center, Catania, Italy. 9. Cardiology Department, Bern University Hospital, Bern, Switzerland. 10. Cardiology Department, Clinique Pasteur, Toulouse, France. 11. Cardiology Department, Evanston Hospital, Evanston, Illinois. 12. Cardiology Department, Antwerp University Hospital, Antwerp, Belgium. 13. Cardiology Department, University of Washington Medical Center, Seattle, Washington. 14. Cardiology Department, University Hospital and National University of Ireland, Galway, Ireland. 15. Cardiovascular Center Frankfurt, Frankfurt, Germany. 16. Teikyo University School of Medicine, Tokyo, Japan. 17. Cardiology Department, Rigshospitalet, Copenhagen, Denmark. 18. Cardiology Division, Columbia University Medical Center, New York, New York. 19. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 20. Cardiology Department, Rabin Medical Center, Petah Tikva, Israel; Cardiology Department, Carmel Medical Center, Haifa, Israel. Electronic address: ran.kornowski@gmail.com.
Abstract
OBJECTIVES: The authors sought to collect data on contemporary practice and outcome of transcatheter aortic valve replacement (TAVR) in oncology patients with severe aortic stenosis (AS). BACKGROUND: Oncology patients with severe AS are often denied valve replacement. TAVR may be an emerging treatment option. METHODS: A worldwide registry was designed to collect data on patients who undergo TAVR while having active malignancy. Data from 222 cancer patients from 18 TAVR centers were compared versus 2,522 "no-cancer" patients from 5 participating centers. Propensity-score matching was performed to further adjust for bias. RESULTS: Cancer patients' age was 78.8 ± 7.5 years, STS score 4.9 ± 3.4%, 62% men. Most frequent cancers were gastrointestinal (22%), prostate (16%), breast (15%), hematologic (15%), and lung (11%). At the time of TAVR, 40% had stage 4 cancer. Periprocedural complications were comparable between the groups. Although 30-day mortality was similar, 1-year mortality was higher in cancer patients (15% vs. 9%; p < 0.001); one-half of the deaths were due to neoplasm. Among patients who survived 1 year after the TAVR, one-third were in remission/cured from cancer. Progressive malignancy (stage III to IV) was a strong mortality predictor (hazard ratio: 2.37; 95% confidence interval: 1.74 to 3.23; p < 0.001), whereas stage I to II cancer was not associated with higher mortality compared with no-cancer patients. CONCLUSIONS: TAVR in cancer patients is associated with similar short-term but worse long-term prognosis compared with patients without cancer. Among this cohort, mortality is largely driven by cancer, and progressive malignancy is a strong mortality predictor. Importantly, 85% of the patients were alive at 1 year, one-third were in remission/cured from cancer. (Outcomes of Transcatheter Aortic Valve Implantation in Oncology Patients With Severe Aortic Stenosis [TOP-AS]; NCT03181997).
OBJECTIVES: The authors sought to collect data on contemporary practice and outcome of transcatheter aortic valve replacement (TAVR) in oncology patients with severe aortic stenosis (AS). BACKGROUND: Oncology patients with severe AS are often denied valve replacement. TAVR may be an emerging treatment option. METHODS: A worldwide registry was designed to collect data on patients who undergo TAVR while having active malignancy. Data from 222 cancerpatients from 18 TAVR centers were compared versus 2,522 "no-cancer" patients from 5 participating centers. Propensity-score matching was performed to further adjust for bias. RESULTS:Cancerpatients' age was 78.8 ± 7.5 years, STS score 4.9 ± 3.4%, 62% men. Most frequent cancers were gastrointestinal (22%), prostate (16%), breast (15%), hematologic (15%), and lung (11%). At the time of TAVR, 40% had stage 4 cancer. Periprocedural complications were comparable between the groups. Although 30-day mortality was similar, 1-year mortality was higher in cancerpatients (15% vs. 9%; p < 0.001); one-half of the deaths were due to neoplasm. Among patients who survived 1 year after the TAVR, one-third were in remission/cured from cancer. Progressive malignancy (stage III to IV) was a strong mortality predictor (hazard ratio: 2.37; 95% confidence interval: 1.74 to 3.23; p < 0.001), whereas stage I to II cancer was not associated with higher mortality compared with no-cancerpatients. CONCLUSIONS: TAVR in cancerpatients is associated with similar short-term but worse long-term prognosis compared with patients without cancer. Among this cohort, mortality is largely driven by cancer, and progressive malignancy is a strong mortality predictor. Importantly, 85% of the patients were alive at 1 year, one-third were in remission/cured from cancer. (Outcomes of Transcatheter Aortic Valve Implantation in Oncology Patients With Severe Aortic Stenosis [TOP-AS]; NCT03181997).
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