Transcatheter Aortic Valve Replacement in Oncology Patients With Severe Aortic Stenosis

Landes, Uri; Iakobishvili, Zaza; Vronsky, Daniella; Zusman, Oren; Barsheshet, Alon; Jaffe, Ronen; Jubran, Ayman; Yoon, Sung Han; Makkar, Raj; Taramasso, Maurizio; Russo, Marco; Maisano, Francesco; Sinning, Jan Malte; Shamekhi, Jasmin; Biasco, Luigi; Pedrazzini, Giovanni; Moscarelli, Marco; Latib, Azeem; Pagnesi, Matteo; Colombo, Antonio; Tamburino, Corrado; Arrigo, Paolo D’; Windecker, Stephan; Pilgrim, Thomas; Tchétché, Didier; Biase, Chiara De; Guerrero, Mayra; Iftikhar, Omer; Bosmans, Johan; Bedzra, Edo; Dvir, Danny; Mylotte, Darren; Sievert, Horst; Watanabe, Yusuke; Søndergaard, Lars; Dagnegård, Hanna; Codner, Pablo; Kodali, Susheel; Leon, Martin B.; Kornowski, Ran

doi:10.1016/j.jcin.2018.10.026

Cited by 63 publications

(72 citation statements)

References 17 publications

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“…These results are similar to our previously published observational study, in which the multivariate analysis revealed radiation therapy as a potential factor for reduced long-term survival [10]. Landes et al also reported similar mortality outcomes for TAVR in the cancer population, and higher mortality appeared to be driven by cancer progression [19]. A recent meta-analysis by Bendary and colleagues showed similar mortality outcomes for TAVR in patients with active cancer [20].…”

Section: Discussionsupporting

confidence: 89%

“…Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) ow chart of the study selection is shown in Figure 1. Major excluded articles [19,[34][35][36][37][38][39] with reasons are reported in the Supplemental Appendix. The 4 included studies enrolled a total of 2054 patients; 164 patients with prior C-XRT, and 1890 patients without prior C-XRT.…”

Section: Literature Search Resultsmentioning

confidence: 99%

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Outcomes After Transcatheter Aortic Valve Replacement in Cancer Survivors with Prior Chest Radiation Therapy: A Systematic Review and Meta-Analysis

Zafar

Mustafa

Miller

et al. 2020

Preprint

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Background : Cancer survivors with prior chest radiation therapy (C-XRT) frequently present with aortic stenosis (AS) as the first manifestation of radiation-induced heart disease. They are considered high-risk for surgical valve replacement. Transcatheter aortic valve replacement (TAVR) is as an attractive option for this patient population but the outcomes are not well established in major clinical trials. The authors performed a systemic review and meta-analysis of clinical studies for the outcomes after TAVR in cancer survivors with prior C-XRT. Methods: Online databases were searched from inception to April 2020 for studies evaluating the outcomes of TAVR in patients with and without C-XRT. We analyzed the pooled estimates (with their 95% confidence intervals) of the odds ratio (OR) for the all-cause mortality at 30-day and 1-year follow-ups, 4-point safety outcomes (stroke, major bleed, access-related vascular complications and need for a pacemaker), a 2-point efficacy outcome (mean aortic valve gradient and left ventricular ejection fraction) and worsening of congestive heart failure (CHF). Four studies were included following 2054 patients with and without prior C-XRT exposure (164 patients and 1890 patients respectively). Results: The C-XRT group had similar 30-day mortality compared to the control group (OR 1.29, 95% CI 0.64 to 2.58, p=0.48). The 1-year mortality was higher in the C-XRT group (OR 1.97, CI 1.15 to 3.39, p=0.01). Apart from higher congestive heart failure (CHF) exacerbation in the C-XRT group (OR 2.03, CI 1.36 to 3.04, p=0.0006), TAVR resulted in similar safety and efficacy outcomes in both groups. Conclusion: TAVR in the C-XRT group has similar 30-day mortality, safety, and efficacy outcomes compared to the control group; however, they have higher 1-year mortality and CHF exacerbation. Including an oncologist to the cardiology team who considers cancer stage in the decision-making process and applying additional preoperative scores such as frailty indices may refine the risk assessment for these patients. The quality of analyzed data is modest, warranting randomized trials to assess the true benefits of TAVR in these patients.

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Section: Discussionsupporting

confidence: 89%

Section: Literature Search Resultsmentioning

confidence: 99%

Outcomes After Transcatheter Aortic Valve Replacement in Cancer Survivors with Prior Chest Radiation Therapy: A Systematic Review and Meta-Analysis

Zafar

Mustafa

Miller

et al. 2020

Preprint

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“…Landes et al, recently reported on outcomes of oncology patients undergoing transcatheter aortic valve implantation. A review of LVAD recipients comparing 2008 to 2017 revealed a rise in the percentages of patients with cancer (3% increasing to 5%), severe diabetes (3%‐9.5%) and peripheral vascular disease (3%‐5%) . Even after successful device implantation, these patients face life‐limiting or morbid conditions in the short term, as well as complicated questions about the interactions between their devices and other diseases.…”

Section: Palliative Care In Relation To Prognosis and Decision‐makingmentioning

confidence: 96%

“…A potentially effective third model ( Figure 2C revealed a rise in the percentages of patients with cancer (3% increasing to 5%), severe diabetes (3%-9.5%) and peripheral vascular disease (3%-5%). 12 Even after successful device implantation, these patients timing of death can be highly variable. Timing of death in the setting of pacemaker and CRT deactivation can also be variable.…”

Section: From Definition To Conceptual Models In Cardiovascular Medmentioning

confidence: 99%

Palliative cardiovascular care: The right patient at the right time

Sullivan

Kirkpatrick

2019

Clinical Cardiology

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In the increasingly complex world of modern medicine, relationship‐centered, team‐based care is important in geriatric cardiology. Palliative cardiovascular care plays a central role in defining the scope and timing of medical therapies and in coordinating symptom‐targeted care in line with patient wishes, values, and preferences. Palliative care addresses advance care planning, symptom relief and caregiver/family support and seeks to ameliorate all forms of suffering, including physical, psychological, and spiritual. Although palliative care grew out of the hospice movement and has traditionally been associated with care at the end of life, the current model acknowledges that palliative care can be delivered concurrent with invasive, life‐prolonging interventions. As the population ages, patients with serious cardiovascular disease increasingly suffer from noncardiac, multimorbid conditions and become eligible for interventions that palliate symptoms but also prolong life. Management of implanted cardiac support devices at the end of life, whether rhythm management devices or mechanical circulatory support devices, can involve a host of complexities in decisions to deactivate, timing of deactivation and even the mechanics of deactivation. Studies on palliative care interventions have demonstrated clear improvements in quality of life and are more mixed on life prolongation and cost savings. There is and will remain a dearth of clinicians with specialist palliative care training. Therefore, cardiovascular clinicians have a role to play in provision of practical, “primary” palliative care.

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“…In a worldwide registry evaluating 222 patients with active malignancy undergoing TAVR, patients had similar short term but worse long-term prognosis, with mortality mainly being driven by cancer. It is notable that at 1 year, up to one third of patients were in remission or cured of their cancer, with TAVR likely being an intervention allowing them to proceed with their cancer treatments [54]. Thus, pre-procedural imaging with CCTA may provide anatomic information of cardiac and vascular disease not only for the structural intervention, but also provide information that may drive long-term cardiovascular treatments to attenuate long-term risk of cardiac events, especially with patients who have a good long-term prognosis with their cancer.…”

Section: Long Term Radiation-induced Valvulopathymentioning

confidence: 99%

Applications of Cardiac Computed Tomography in the Cardio-Oncology Population

Layoun

Yang

Herrmann

et al. 2019

Curr. Treat. Options in Oncol.

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Opinion statementThe increased risk for cardiovascular events in aging cancer survivors and those undergoing certain chemotherapeutic treatments has raised concern for more rigorous screening and surveillance methods above that of the general population. At this time, there are limited guidelines for how to best manage this vulnerable cohort. Questions regarding timing of screening, choice of imaging modality and risk reduction strategies-especially in those patients with known atherosclerotic disease-remain to be elucidated. Over a decade of case series, retrospective studies and clinical trials have shed light on the evolving role of cardiac computed tomography (CT) in this population, of which there is a relative paucity of data regarding its potential utility in the specific cardio-oncology population. Focusing on ability of cardiac CT to evaluate multiple cardiac and vascular structures, provide diagnostic and prognostic information, as well as assist interventional and surgical colleagues in surgical/percutaneous valve replacement and revascularization strategies is the premise for this review.

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Transcatheter Aortic Valve Replacement in Oncology Patients With Severe Aortic Stenosis

Cited by 63 publications

References 17 publications

Outcomes After Transcatheter Aortic Valve Replacement in Cancer Survivors with Prior Chest Radiation Therapy: A Systematic Review and Meta-Analysis

Outcomes After Transcatheter Aortic Valve Replacement in Cancer Survivors with Prior Chest Radiation Therapy: A Systematic Review and Meta-Analysis

Palliative cardiovascular care: The right patient at the right time

Applications of Cardiac Computed Tomography in the Cardio-Oncology Population

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