Background Patients with severe aortic stenosis and
concomitant active cancer (AC) are considered high-risk
patients and usually are not allowed to undergo surgical
valve replacement. Transcatheter aortic valve replacement
(TAVR) may be an attractive option for them; however, little
is known about the outcomes of TAVR in this subset of
complex patients.
Methods and results In this meta-analysis,
Medline,
Cochrane Library and Scopus databases were searched
(anytime up to April 2019) for studies evaluating the
outcomes of TAVR in patients with or without AC. We
assessed pooled estimates (with their 95% CIs) of the
risk ratio (RR) for the all-cause
mortality at the 30-day
and 1-year
follow-ups,
a 4-point
safety outcome (any
bleeding, stroke, need for a pacemaker and acute kidney
injury) and a 2-point
efficacy outcome (device success and
residual mean gradient (mean difference)). Three studies
(5162 patients) were included. Of those patients, a total
of 368 (7.1%) had AC. Apart from a significantly higher
need for a postprocedural pacemaker (RR 1.29, 95% CI
1.06 to 1.58, p=0.01), TAVR in patients with AC resulted
in similar outcomes for safety and efficacy at the 30-day
follow-up
compared with those without AC. Patients with
AC experienced similar rates of the all-cause
mortality
at the 30-day
follow-up
compared with those without
(RR 0.92, 95% CI 0.53 to 1.59, p=0.76); however, the all-cause
mortality was significantly higher in patients with
AC at the 1-year
follow-up
(RR 1.71, 95% CI 1.26 to 2.33,
p=0.0006). This mortality difference was independent of
cancer stage (advanced or limited) at the 30-day
follow-up
but not at the 1-year
follow-up;
only patients with limited
cancer stages showed similar all-cause
mortality rates
compared with those without cancer at the 1-year
follow-up
(RR 1.22, 95% CI 0.79 to 1.91, p=0.37).
Conclusion TAVR in patients with AC is associated with
similar 30-day
and potentially worse 1-year
outcomes
compared with those in patients without AC. The 1-year
all-cause
mortality appears to be dependent on the cancer
stage. Involving a specialised oncologist who usually
considers cancer stage in the decision-making
process
and applying additional preoperative scores such as frailty
indices might refine the risk assessment process among
these patients. |
