TY - JOUR
T1 - An update on the management and outcomes of cancer patients with severe aortic stenosis
AU - Schechter, Michael
AU - Balanescu, Dinu Valentin
AU - Donisan, Teodora
AU - Dayah, Tariq J.
AU - Kar, Biswajit
AU - Gregoric, Igor
AU - Giza, Dana E.
AU - Song, Juhee
AU - Lopez-Mattei, Juan
AU - Kim, Peter
AU - Balanescu, Serban Mihai
AU - Cilingiroglu, Mehmet
AU - Toutouzas, Konstantinos
AU - Smalling, Richard W.
AU - Marmagkiolis, Konstantinos
AU - Iliescu, Cezar
N1 - Publisher Copyright:
© 2018 Wiley Periodicals, Inc.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Objectives: We compared the outcomes of aortic valve replacement (AVR) by transcatheter (TAVR) and surgical (SAVR) routes with those of optimal medical management in patients with cancer and severe aortic stenosis (AS). Background: Cancer therapy requires optimal cardiac output; however, the treatment of AS in cancer patients is not established. Methods: Cancer patients with severe AS during January 2009 through February 2018 at a large cancer center were identified. Demographic and clinical characteristics including previous or active cancer diagnosis, history of chest radiotherapy, AS treatment, and survival were collected. Univariate Cox proportional hazards regression, the Kaplan–Meier analysis, and log-rank tests were used to compare overall survival (OS) between AS treatment groups. Results: Sixty-five cancer patients with severe AS were identified; 28 received optimal medical treatment alone, 30 received TAVR, and seven received SAVR. The patients were predominantly male (n = 44, 68%) with a mean age of 71.17 years. The median OS was 9.87 months, and the most common cause of death was cancer (n = 29, 94% of deaths). AVR was associated with a lower risk of death than no AVR (hazard ratio [HR] 0.38, P = 0.007), and patients who underwent TAVR (HR 0.36, P = 0.01) had better survival than those with no AVR. Malignancy type, stage, and treatment were not associated with OS. Conclusions: Patients with cancer and severe AS who underwent AVR, predominantly TAVR, experienced better survival than those who had no AVR regardless of cancer type or cancer treatment. TAVR may be considered in patients with cancer and AS.
AB - Objectives: We compared the outcomes of aortic valve replacement (AVR) by transcatheter (TAVR) and surgical (SAVR) routes with those of optimal medical management in patients with cancer and severe aortic stenosis (AS). Background: Cancer therapy requires optimal cardiac output; however, the treatment of AS in cancer patients is not established. Methods: Cancer patients with severe AS during January 2009 through February 2018 at a large cancer center were identified. Demographic and clinical characteristics including previous or active cancer diagnosis, history of chest radiotherapy, AS treatment, and survival were collected. Univariate Cox proportional hazards regression, the Kaplan–Meier analysis, and log-rank tests were used to compare overall survival (OS) between AS treatment groups. Results: Sixty-five cancer patients with severe AS were identified; 28 received optimal medical treatment alone, 30 received TAVR, and seven received SAVR. The patients were predominantly male (n = 44, 68%) with a mean age of 71.17 years. The median OS was 9.87 months, and the most common cause of death was cancer (n = 29, 94% of deaths). AVR was associated with a lower risk of death than no AVR (hazard ratio [HR] 0.38, P = 0.007), and patients who underwent TAVR (HR 0.36, P = 0.01) had better survival than those with no AVR. Malignancy type, stage, and treatment were not associated with OS. Conclusions: Patients with cancer and severe AS who underwent AVR, predominantly TAVR, experienced better survival than those who had no AVR regardless of cancer type or cancer treatment. TAVR may be considered in patients with cancer and AS.
KW - aortic valve disease
KW - aortic valve disease, percutaneous intervention
KW - surgery, aortic
KW - transcatheter valve implantation
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U2 - 10.1002/ccd.28052
DO - 10.1002/ccd.28052
M3 - Article
C2 - 30549397
AN - SCOPUS:85058665566
SN - 1522-1946
VL - 94
SP - 438
EP - 445
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 3
ER -