Structural Transcatheter Cardiac Interventions in the Cardio-Oncology Population

Abstract

Modern cancer therapies have resulted in prolonged survival and decreased mortality for many types of cancer. Consequently, cancer patients with concomitant cardiovascular disease (CVD) present prior to diagnosis of cancer, resulting from various forms of cancer therapy, or developing after cancer remission are at higher risk for development of cardiovascular-associated morbidity and mortality. Management of CVD, particularly structural heart disease, in this patient population is challenging and associated with elevated surgical risk. Minimally invasive transcatheter procedures have emerged as lower risk treatment modalities that have been shown to be safe and efficacious. This review will evaluate the current literature on percutaneous management of aortic stenosis (AS), mitral regurgitation (MR), tricuspid regurgitation (TR), and intracardiac thrombus (ICTE) or masses in cancer patients. Multiple cohort- and registry-based studies have demonstrated safe and efficacious implementation of transcatheter interventions for the management of severe AS and MR in cancer patients. The development of transcatheter interventions for severe TR is promising and may also be considered for this high-risk patient population. Interestingly, management of ICTE and cardiac masses has also been achieved with a novel transcatheter approach. While a multidisciplinary heart team approach is necessary to properly manage cancer patients with structural heart disease and ICTE, more robust registry-based and prospective clinical trials are required to meet the needs of a rapidly growing cardio-oncology patient population.