Abstract
Objectives: This study sought to systematically analyze the available clinical evidence on TAVR therapy in cancer patients with symptomatic severe AS.Background: Aortic stenosis is the most common valvular heart disease in the world. TAVR has expanded the treatment options for this lethal disease process. The safety and efficacy of TAVR in cancer patients has not yet been reliably established. We thus conducted the largest known multi-center meta-analysis on TAVR and cancer status.Methods: We performed a literature search using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from January 2015 to 2020. Studies that compared the use of TAVR in patients with severe symptomatic aortic stenosis and cancer against patients without cancer were included. Meta-regression was also conducted to determine if common clinical factors modified the possible association between cancer status and TAVR mortality.Results: Five studies with 11,129 patients in the cancer group and 41,706 patients in the control group met inclusion criteria. The short-term mortality in the cancer group was 2.4% compared with 3.3% in the control group (odds ratio: 0.72, 95% confidence interval: 0.63–0.82; p < 0.0001). The frequency of stroke was 2.4% compared with 2.7% (odds ratio of 0.87, 95% confidence interval: 0.76–0.99; p < 0.04). The frequency of AKI was 14.2% in cancer patients vs. 16.4% (odds ratio of 0.81, 95% confidence interval: 0.76–0.85; p < 0.04). The rates of bleeding and need for new pacemaker implantation were not significantly different. Meta-regression demonstrated there was no significant association modifying.Conclusions: On the basis of the results of this meta-analysis TAVR may be a safe and effective therapeutic option for patients with cancer and symptomatic severe aortic stenosis. Larger, longer, and randomized trials are required to adequately test this above hypothesis.
Highlights
Aortic stenosis (AS) is the most common valvular heart disease in the world with ∼500,000 patients with severe aortic stenosis in the United States alone [1]
As one of the most important advancements of the past 10+ years, Transcatheter Aortic Valve Replacement (TAVR) has expanded the treatment options for this lethal disease process and it is FDA-approved for patients with inoperable, high, intermediate, and low risk for surgical aortic valve replacement (SAVR) [4]
Patients with cancer often carry a high burden of comorbidity and may be deemed to be ideal candidates for TAVR
Summary
Aortic stenosis (AS) is the most common valvular heart disease in the world with ∼500,000 patients with severe aortic stenosis in the United States alone [1]. These patients have been traditionally excluded from TAVR randomized controlled trials (RCT); the safety and efficacy of TAVR in cancer patients has not yet been reliably established. While conditions associated with cancer and cancer therapy (anemia, thrombocytopenia, bleeding diathesis, thrombophilia, and increased frailty) may argue for a transcatheter approach, they may, at the same time complicate transcatheter interventions. This comprehensive review and meta-analysis seeks to systematically analyze the available clinical evidence on TAVR therapy in cancer patients with symptomatic severe AS. We conducted the largest known multi-center meta-analysis on TAVR and cancer status
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