Cancer patients do not face a greater risk of in-hospital mortality after transcatheter aortic valve replacement (TAVR) than patient without cancer, according to new findings published in the Journal of the American Heart Association.[1] However, there are other risks cardiologists should know about before considering TAVR for a patient with active cancer.
“Current evidence on outcomes after TAVR in patients with active cancer is relatively limited, because pivotal randomized trials of TAVR excluded patients with a limited life expectancy,” wrote first author Tadao Aikawa, MD, PhD, an interventional cardiologist with Juntendo University Urayasu Hospital in Japan, and colleagues. “In practice, however, the outcomes of patients with cancer can be difficult to predict, and TAVR may offer these patients a chance to be effectively treated for cancer, particularly with reduced postprocedural acute kidney injury and major bleeding compared with surgical aortic valve replacement.”
Aikawa et al. examined data from the U.S. Nationwide Readmissions Database, focusing on more than 122,000 TAVR patients treated from 2012 to 2019. 2020 was used as a cut-off date due to more low-risk patients undergoing TAVR at that time.
More than 6% of all patients presenting for TAVR had active cancer. TAVR patients with active cancer were less likely to present with hypertension, diabetes, obesity, coronary artery disease or a history of myocardial infarction than TAVR patients without cancer. The mean cost of hospitalization was much higher among patients with colon cancer, lung cancer and any type of metastatic cancer than it was among patients without cancer.
Overall, the authors wrote, “crude” in-hospital mortality and readmission after 30 days, 90 days and 180 days were all higher among patients with cancer than those without cancer. After adjusting for baseline characteristics, however, active cancer was no longer associated with an increased risk of in-hospital mortality, but it was still linked to a greater risk of readmission at 30 days, 90 days and 180 days. Active cancer was also associated with a heightened 30-day risk of bleeding events that require transfusion.
Another key takeaway was that active breast cancer and any type of metastatic cancer were linked to a much higher risk of permanent pacemaker implantation (PPM).
“These results suggest that TAVR may be a treatment option for certain patients with active cancer and severe aortic stenosis,” the authors wrote. “An individualized approach to these patients is needed to determine the benefit of TAVR and dictate personalized treatment strategies based on the types and extent of cancers. Long‐term follow‐up data and randomized controlled trials are needed to further investigate this topic.”
Click here to read the full analysis.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.