In patients with active cancer undergoing TAVI, 1-year mortality was 23% and median survival was 11.5 months, emphasizing need for careful selection.
What are the clinical outcomes and mortality rates of TAVI in patients with active cancer and severe aortic stenosis?
TAVI in patients with active cancer is feasible and can serve as a bridge to oncologic treatment, though it is associated with a 23% 1-year mortality rate.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background and Aim Oncologic disease is an increasingly prevalent condition that introduces additional challenges for transcatheter aortic valve intervention (TAVI) due to associated comorbidities and its impact on long-term outcomes. This study assessed the prognosis of patients with active cancer and concomitant aortic stenosis (AS) deemed eligible for TAVI. Methods Retrospective single-center study of patients with active cancer - defined as malignancy undergoing treatment, planned for treatment, or with treatment completed within one year - who underwent TAVI between November 2008 and October 2024. Eligible patients had severe AS or bioprosthetic valve dysfunction and underwent either transcatheter aortic valve replacement (TAVR) or balloon aortic valvuloplasty (BAV), with BAV used as a bridging procedure in cases of uncertain prognosis. Data on demographics, clinical and echocardiographic parameters, malignancy characteristics, procedural details, and follow-up outcomes were analyzed. Results Among 2185 TAVI patients, 71 (3.2%) had active cancer (mean age 77±15 years; 51% male). Most had solid tumors (87%, n=62), predominantly gastrointestinal (31%, n=22) and prostate (16%, n=11). Cancer stages included localized (stage 1/2 40%, n=28), locoregionally advanced (24%, n=17), and metastatic disease (21%, n=15). Patients had high surgical risk and significant comorbidities (mean EuroSCORE II 6.8±7.0%; Charlson index 8.0±1.8; Karnofsky score 80±12). Bleeding was a common cancer-related symptom (25%, n = 18), particularly in gastrointestinal cancers (15%, n = 11). The mean aortic gradient was 45.9±11.1 mmHg, and 17% (n=12) had left ventricular ejection fraction 40%. Most were severely symptomatic (NYHA III/IV 52%, n=37) with a median NT-proBNP of 1959 pg/mL (IQR 815–4064). In 40 patients (56%) with stable cancer and symptomatic AS, TAVR was performed at a median of 1.9 years (IQR 1.0-1.7) after cancer diagnosis. In this group, 23% (n = 9) died within the first-year post-procedure. The remaining 31 patients (44%) had recent cancer diagnoses prior to TAVI (median 3.9 months, IQR 2.9-7.0), and intervention was conducted to ensure eligibility for oncologic treatment regardless of AS symptoms. In this group, BAV was initially performed in 12 patients, with 7 subsequently undergoing TAVR after a median of 8.4 months (IQR 7.6–10.3). Following TAVI, 71% (n=22) received oncologic treatment, primarily surgery (29%, n=9). In this subset, 23% (n = 7) died within the first-year post-procedure. Overall mortality was 23% at 1 year and 44% over a median follow-up of 1.4 years (IQR 0.5–2.5), with a median survival of 11.5 months (IQR 3.7–24.6). Conclusion Careful patient selection and a multidisciplinary approach are crucial for optimizing outcomes in patients with active cancer undergoing TAVI. Further research is needed to evaluate long-term outcomes in this population.
Carvalho et al. (Sat,) reported a other. In patients with active cancer undergoing TAVI, 1-year mortality was 23% and median survival was 11.5 months, emphasizing need for careful selection.