TAVR remains a viable treatment strategy for cancer patients
Patients with active cancer who undergo transcatheter aortic valve replacement (TAVR) are associated with short- and mid-term outcomes comparable to those without cancer, according to new findings published in the International Journal of Cardiology.[1] Long-term mortality rates appear to be higher for cancer patients, though there is considerable variability from one type to the next.
“Cancer and aortic valve stenosis (AS) are among the leading causes of mortality in developed countries,” wrote first author Mark Kheifets, MD, a researcher with the cardiology division at Rabin Medical Center in Israel, and colleagues. “Advances in cancer diagnosis and treatment have significantly improved survival rates in recent years, leading to a growing number of patients diagnosed with both cancer and AS. Additionally, individuals with a history of cancer treatments, particularly those exposed to chest radiation, face an elevated risk of developing AS. Although severe AS portends a similarly poor prognosis as cancer without treatment, managing AS in patients with cancer may pose unique challenges, as these individuals are often frail, burdened with multiple comorbidities, and may experience increased thrombogenicity due to malignancy and its treatments. Furthermore, they are often prone to lower hemoglobin and platelet counts, increasing their risk of bleeding complications.”
Kheifets et al. tracked registry data from more than 1,500 patients who underwent TAVR at a single tertiary center from 2013 to 2022. While 3.5% of patients had active cancer, another 8.1% had a history of cancer. The remaining 88.4% had no history at all of cancer.
Patients with active cancer were significantly younger than other patients. This group was also linked to lower rates of previous percutaneous coronary intervention and higher estimated glomerular filtration rates than the other two patient groups. Rates of previous myocardial infarction and previous coronary artery bypass graft, meanwhile, were similar for all three groups.
Overall, the group found that there were no significant differences between patients with active cancer and those with a history of cancer or no cancer at all when it came to all-cause mortality after 30 days or one year. At three years, however, mortality was significantly higher for patients with active cancer. As one may expect, intermediate and high Society of Thoracic Surgeons risk scores were independently associated with an increased risk of three-year mortality.
Another key takeaway was the fact that TAVR is becoming more and more common for both active cancer patients and those with a history of cancer.
“This trend likely reflects growing confidence in procedural safety and multidisciplinary decision-making frameworks,” the authors wrote. “It also raises important considerations around health resource planning and equitable access. As the population of cancer survivors—and those living with cancer as a chronic condition for many years—continues to grow, cardiovascular comorbidities such as aortic stenosis will become increasingly common. This evolution necessitates the formal integration of oncologic input into heart team decision-making to ensure optimal patient selection and care delivery in this complex population.”
Kheifets and colleagues also found that patients with active gastrointestinal cancer were associated with a higher all-cause mortality rate than any other subgroup. Patients with active breast cancer faced the lowest risk of all-cause mortality.
Reviewing these data, the authors pointed to TAVR as a safe, effective treatment strategy for cancer patients presenting with severe AS.
“Overall, our study supports the growing recognition that TAVR is a viable option for cancer patients with severe AS, with comparable short- and mid-term safety but natural increase in long-term mortality risk, particularly in those with active or metastatic disease,” the group wrote. “It is important to note that, in some cases, treating severe AS may be essential to enabling the initiation or continuation of effective cancer treatment; in our study, 17% of patients with active cancer underwent TAVR with the indication of facilitating cancer treatment administration. The minimally invasive nature of TAVR may be particularly appealing in these complex cases.”
Click here to read the full analysis.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.