Efficacy and follow-up of transcatheter aortic valve implantation in patients with radiation-induced aortic stenosis

Abstract

ObjectiveTo investigate transcatheter aortic valve implantation (TAVI) feasibility, effectiveness and safety in radiation-induced aortic valve stenosis cases.Methods198 consecutive patients referred for TAVI were prospectively enrolled. They were divided into two groups: patients with a history of chest radiation therapy with suspected radiation-induced valvular disease (RXT) and others with suspected degenerative aortic valve stenosis (NRXT). Procedural, early and mid-term clinical outcomes were compared.ResultsOf the 198 patients enrolled in our study, 9.6% qualified for inclusion in the RXT group. A comparison of baseline characteristics revealed that patients with RXT were younger than patients with NRXT (68.3 vs 82.5 years; p<0.05) and exhibited a lower surgical risk score (Euroscore: 7.1% vs 21.8%; p<0.05) and a higher frequency of hostile thorax and porcelain aorta (52.6% vs 28.5%; p<0.05; 63.2% vs 10.6%; p<0.05, respectively). In both groups, the implantation success rate was high and the 30-day safety end point acceptable (RXT: 94.7% and 83.3%; NRXT: 93.9% and 75.6%, respectively). At 6 months, overall mortality was significantly lower in the RXT group (0% vs 18%; p=0.048).ConclusionsIn patients suffering from radiation-induced aortic valve stenosis and contraindicated for surgery, TAVI is a promising approach, with high feasibility, acceptable risk, low mortality and high clinical effectiveness at mid-term follow-up.

Reexamining the Role of Surgical Aortic Valve Replacement After Mediastinal Radiation Therapy

“…Therefore, although operative mortality in our series was very low among patients undergoing isolated AVR, considering the overall poor midterm survival of these patients which reduces the significance of valve durability, use of TAVR may be considered for selected patients (frail patients, patients at risk of PPM, or patients who may be candidates for concomitant percutaneous coronary intervention). Currently, the only available study comparing outcomes of TAVR among patients with previous MRT versus patients without demonstrated significantly lower 6-month mortality for the MRT group (0% versus 18%) [18]. Alternatively, despite the limited pool of organ donors, cardiac transplantation should be considered for selected patients with severe MRT-induced disease requiring extensive surgical repairs.…”

“…From 2000 to 2016, 49 consecutive patients previously exposed to MRT underwent AVR with or without concomitant procedures at a single center. Patients were divided into two groups: isolated AVR (n [ 18) and AVR with concomitant procedures (n [ 31). The logistic European System for Cardiac Operative Risk Evaluation II mean score was 2.8% ± 3.4% and The Society of Thoracic Surgeons mean score was 1.7% ± 1.5%.…”

Outcomes of cardiac surgery after mediastinal radiation therapy: A single‐center experience

“…Percutaneous approaches (eg, transfemoral and transapical) could have beneficial outcomes since they eliminate the issues caused by the late effects of MRT, such as the calcification of the aorta (problems with cannulation and clamping) and extensive mediastinal fibrosis. Dijos et al 20 already showed promising outcomes of TAVI with low postoperative mortality and complications and good hemodynamic results. Future studies will have to compare the results of conventional surgery vs TAVI in patients with previous MRT and aortic valve stenosis.…”

Applications of Cardiac Computed Tomography in the Cardio-Oncology Population

“…Mitral and aortic valves are most commonly affected, resulting in either insufficiency or stenosis, with symptomatology ranging from mild to severe [3]. The reported prevalence of valve dysfunction ranges from 5-40% and typically presents 15 to 20 years after initial radiation exposure [49]. These patients are often younger at time of valve replacement, and undergo valve surgery more often than the general population [50].…”