Prognosis of patients with history of oncological disease undergoing transcatheter aortic valve replacement

Background

A prior history of oncological disease (OD) is frequently encountered in elderly patients, including those candidates for transcatheter aortic valve replacement (TAVR). In this subset of patients, the Heart Team could be reluctant to perform TAVR due to prognostic reason.

Purpose

We sought to assess the impact of prior OD on one-year outcome following TAVR.

Methods

An observational single-center study involving all patients who underwent TAVR from 2009 to 2019. History of OD was classified as follows: no prior history of OD; cured OD (complete remission ≥ 5 years); stable OD (complete remission < 5 years or partial remission); and active or metastatic OD (scheduled/ongoing treatment or the presence of metastasis, after oncology assessment to ascertain TAVR candidacy).

Results

A total of 412 patients (mean age 79.6 ± 7.8 years, mean STS score 5.3 ± 3.6) were included. A prior history of OD was found in 73 patients (17.7%). Solid cancers accounted for 81.7% and hematologic malignancies for 18.3% of cases. OD was considered cured in 29 patients (7%), stable in 25 (6.1%), while the remaining 19 patients (4.6%) had active or metastatic OD. In patients with prior OD, diabetes, prior coronary artery bypass grafting and prior stroke were less prevalent, while chronic kidney disease was more prevalent in comparison with patients with no prior OD. No in-hospital death occurred in patients with prior OD while a trend for higher prevalence of in-hospital stroke was observed when compared with patients with no prior OD (5.5% vs. 1.8%; P = 0.062). One-year survival was similar between patients with and without prior history of OD (90% vs. 93.2%; P = 0.422). In comparison with patients with no previous history of OD, those with cured OD, stable OD and active or metastatic OD had similar one-year survival (all P > 0.05) (Fig. 1).

Conclusion

Prior history of OD did not impact on one-year survival following TAVR in this cohort where patients with active OD were carefully assessed.