TY - JOUR
T1 - Transcatheter and surgical aortic valve replacement impact on outcomes and cancer treatment schedule
AU - Gill, Clarence
AU - Lee, Michelle
AU - Balanescu, Dinu Valentin
AU - Donisan, Teodora
AU - Serauto Canache, Astrid Josefina
AU - Palaskas, Nicolas
AU - Lopez-Mattei, Juan
AU - Kim, Peter Y.
AU - Song, Juhee
AU - Yang, Eric H.
AU - Cilingiroglu, Mehmet
AU - Kar, Biswajit
AU - Gregoric, Igor
AU - Marmagkiolis, Konstantinos
AU - Iakobishvili, Zaza
AU - Iliescu, Cezar
N1 - Publisher Copyright:
© 2020
PY - 2021/3/1
Y1 - 2021/3/1
N2 - 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.
AB - 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.
KW - Aortic valve replacement
KW - Cancer
KW - Degenerative calcific severe aortic stenosis
KW - Overall survival
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U2 - 10.1016/j.ijcard.2020.08.071
DO - 10.1016/j.ijcard.2020.08.071
M3 - Article
C2 - 32858137
AN - SCOPUS:85097100450
SN - 0167-5273
VL - 326
SP - 62
EP - 70
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -