TAVR a safe treatment option for patients who have undergone chest radiation therapy
Transcatheter aortic valve replacement (TAVR) is a reasonable treatment option for heart patients who have previously been exposed to mediastinal radiation, according to new research published in JSCAI.[1]
“Irrespective of the surgical risk, TAVR provides an alternative to surgical aortic valve replacement (SAVR) for patients with symptomatic severe aortic stenosis; however, patients with prior mediastinal radiation were largely underrepresented in the pivotal TAVR trials,” wrote first author Hossam Elbenawi, MD, a senior clinical research fellow with the department of cardiovascular medicine at Mayo Clinic, and colleagues. “Limited data have suggested that TAVR is associated with favorable short-term mortality and morbidity compared with SAVR among these patients. However, the long-term outcomes of TAVR vs SAVR in patients with prior mediastinal radiation remain unknown.”
Elbenawi et al. reviewed data from more than 900 patients with prior chest radiation who underwent isolated TAVR or SAVR from 2010 to 2025. Approximately 63% of those patients were women. All data came from the TriNetX Research Network, a database of more than 250 million U.S. patients. Patients included in this analysis had previously received mediastinal radiation to treat a variety of issues, including malignant neoplasms in the breast, esophagus, thymus, heart, bronchus or lung.
In total, 63.2% of the 933 patients were women. While 84.1% of patients underwent TAVR, the remaining 15.8% underwent SAVR. Mean ages were 76.1 years old for the TAVR patients and 65.6 years old for the SAVR patients.
TAVR patients were more likely to present with hypertension, diabetes, chronic ischemic heart disease, heart failure, atrial fibrillation, peripheral vascular disease, carotid artery stenosis, or a history of smoking than SAVR patients. In addition, they were linked to a lower mean estimated glomerular filtration rate and were more likely to be on beta blockers, statin therapy, daily aspirin or oral anticoagulants. To help account for these differences, the authors used propensity score matching to focus on two comparable groups of 128 patients.
Overall, the authors found that five-year outcomes were similar for TAVR and SAVR. This included comparable rates of death, nonelective hospitalizations and ischemic stroke/transient ischemic attack.
“Long-term occurrence of cardiovascular adverse effects associated with cancer treatments, including radiation-related therapies, has garnered significant interest as cancer survival outcomes have improved in recent years,” the authors wrote. “Despite the high prevalence of aortic stenosis in patients with mediastinal radiotherapy, there are only a limited number of studies comparing TAVR and SAVR in that patient population, particularly with a focus on long-term outcomes. Our study revealed that the mortality rates for TAVR and SAVR were comparable at five years.”
A history of heart failure, a history of lung cancer and advancing age were all linked to an increased risk of mortality. The procedural approach—TAVR or SAVR—did not make a significant impact on that risk.
The researchers did emphasize that more research into this topic is still necessary.
“Larger prospective studies are needed to better inform clinical decision-making in this high-risk population,” they wrote.
Click here to read the full study in JSCAI, the flagship journal of the Society for Cardiovascular Angiography and Interventions.
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.