Clarence Gill1, Michelle Lee2, Dinu Valentin Balanescu3, Teodora Donisan3, Astrid Josefina Serauto Canache2, Nicolas Palaskas3, Juan Lopez-Mattei3, Peter Y Kim3, Juhee Song4, Eric H Yang5, Mehmet Cilingiroglu6, Biswajit Kar2, Igor Gregoric2, Konstantinos Marmagkiolis7, Zaza Iakobishvili8, Cezar Iliescu9. 1. Division of Cardiology, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA; Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 2. Division of Cardiology, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA. 3. Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 4. Division of Biostatistics, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA. 6. School of Medicine, Bahcesehir University, Istanbul, Turkey. 7. Department of Cardiology, Advent Health, Zephyrhills, Florida, USA. 8. Department of Cardiology, Tel Aviv Jaffa District, Clalit Health Fund, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 9. Division of Cardiology, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA. Electronic address: CIliescu@mdaderson.org.
Abstract
BACKGROUND: Recent data suggest that transcatheter aortic valve replacement (TAVR) for the treatment of severe aortic stenosis (AS) is viable in cancer patients. TAVR may be preferred in cancer patients due to its minimally invasive nature and smaller impact on oncologic therapies compared to SAVR. Objectives We sought to determine if TAVR is an acceptable alternative to SAVR in cancer patients and whether TAVR allows for earlier initiation or resumption of anti-cancer therapies. METHODS: Cancer patients in a tertiary cancer center diagnosed with severe AS were retrospectively included. Patients accepted by the heart team underwent either TAVR or SAVR, while remaining patients received medical therapy alone. Time intervals to initiation of cancer treatment and the impact of cancer treatment on the replaced valves were recorded. Logistic regression was performed to determine the impact of treatment strategy on overall survival (OS) in all 3 subgroups. RESULTS: One hundred and eighty-seven cancer patients diagnosed with severe AS were identified. AVR was associated with better OS compared to medical therapy alone (p < 0.0001). TAVR was associated with better OS at 72 months (HR = 0.468, p < 0.001) compared to medical therapy alone, with no difference in OS observed between SAVR and TAVR. Time intervals to initiation of cancer treatments were shorter in the TAVR group, with no valve deterioration or infection observed in all groups. CONCLUSION: Cancer patients with severe AS benefit from AVR. TAVR is a viable alternative to SAVR in high-risk cancer patients to prolong survival and allow for earlier administration or resumption of anti-neoplastic therapies.
BACKGROUND: Recent data suggest that transcatheter aortic valve replacement (TAVR) for the treatment of severe aortic stenosis (AS) is viable in cancerpatients. TAVR may be preferred in cancerpatients due to its minimally invasive nature and smaller impact on oncologic therapies compared to SAVR. Objectives We sought to determine if TAVR is an acceptable alternative to SAVR in cancerpatients and whether TAVR allows for earlier initiation or resumption of anti-cancer therapies. METHODS:Cancerpatients in a tertiary cancer center diagnosed with severe AS were retrospectively included. Patients accepted by the heart team underwent either TAVR or SAVR, while remaining patients received medical therapy alone. Time intervals to initiation of cancer treatment and the impact of cancer treatment on the replaced valves were recorded. Logistic regression was performed to determine the impact of treatment strategy on overall survival (OS) in all 3 subgroups. RESULTS: One hundred and eighty-seven cancerpatients diagnosed with severe AS were identified. AVR was associated with better OS compared to medical therapy alone (p < 0.0001). TAVR was associated with better OS at 72 months (HR = 0.468, p < 0.001) compared to medical therapy alone, with no difference in OS observed between SAVR and TAVR. Time intervals to initiation of cancer treatments were shorter in the TAVR group, with no valve deterioration or infection observed in all groups. CONCLUSION:Cancerpatients with severe AS benefit from AVR. TAVR is a viable alternative to SAVR in high-risk cancerpatients to prolong survival and allow for earlier administration or resumption of anti-neoplastic therapies.
Authors: Nikitha Kosaraju; Perry Wu; Mei Leng; Marielle Bolano; Asim M Rafique; John Shen; Nancy Satou; Jeanne Huchting; Deena Goldwater; Olcay Aksoy; Eric H Yang Journal: Clin Cardiol Date: 2022-10-04 Impact factor: 3.287