title: Two-year survival of patients screened for transcatheter aortic valve replacement with potentially malignant incidental findings in initial body computed tomography.
abstract: OBJECTIVE
  Recently, transcatheter aortic valve replacement (TAVR) has evolved as the standard treatment in patients with inoperable aortic valve stenosis. According to TAVR guidelines, body computed tomography (CT) is recommended for pre-procedural planning. Due to the advanced age of these patients, multiple radiological potentially malignant incidental findings (pmIFs) appear in this cohort. It is unknown how pmIFs influence the decision by the heart team to intervene and the mortality.
  
  
  RESULTS
  We evaluated in a retrospective single-centre observational study 414 participants screened for TAVR with dual-source CT between October 2010 and December 2012. pmIFs are common and appeared in 18.7% of all patients screened for TAVR. The decision to intervene by TAVR or surgical aortic valve replacement (SAVR) was made by an interdisciplinary heart team and the role of pmIF in decision-making and time to treatment with TAVR or SAVR was analysed, retrospectively. The appearance of a pmIF vs. no pmIF did not significantly influence therapeutic decisions [odds ratio (OR) 1.14; P = 0.835] or time to treatment (91 ± 152 vs. 61 ± 109 days, respectively). Several findings, which are highly suspicious for malignancy, were less likely associated with invasive treatment (OR 0.207; P = 0.046). Patient survival was evaluated for at least 2 years until January 2014. Two-year survival of patients after TAVR or SAVR, treated according to the heart team decision, was ∼75% and independent from the presence of a non-severe (P = 0.923) or severe (P = 0.823) pmIF.
  
  
  CONCLUSIONS
  The study indicates that frequently occurring radiologic pmIF did not influence 2-year survival after a decision to intervene was made by an interdisciplinary heart team.
authors.affiliation: Department of Cardiology and Angiology I, University Heart Center Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Stachon
authors.affiliation: Center for Medical Biometry and Medical Informatics, Medical Center, University of Freiburg, Freiburg, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Kaier
authors.affiliation: Department of Cardiology and Angiology I, University Heart Center Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
authors.forename: Simone
authors.initials: S
authors.lastname: Milde
authors.affiliation: Department of Radiology, Center for Diagnostic and Therapeutic Radiology, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Gregor
authors.initials: G
authors.lastname: Pache
authors.affiliation: Department of Cardiology and Angiology I, University Heart Center Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Sorg
authors.affiliation: Department of Cardiology and Angiology I, University Heart Center Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Siepe
authors.affiliation: Department of Cardiology and Angiology I, University Heart Center Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
authors.forename: Constantin
authors.initials: C
authors.lastname: von zur Mühlen
authors.affiliation: Department of Cardiology and Angiology I, University Heart Center Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Zirlik
authors.affiliation: Department of Cardiology and Angiology I, University Heart Center Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Beyersdorf
authors.affiliation: Department of Radiology, Center for Diagnostic and Therapeutic Radiology, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Langer
authors.affiliation: Department of Cardiology and Angiology I, University Heart Center Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Zehender
authors.affiliation: Department of Cardiology and Angiology I, University Heart Center Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Bode
authors.affiliation: Department of Cardiology and Angiology I, University Heart Center Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany jochen.reinoehl@universitaets-herzzentrum.de.
authors.forename: Jochen
authors.initials: J
authors.lastname: Reinöhl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D033162:Incidental Findings; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality*; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods / Q000401:mortality*; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: TAVI; TAVR; aortic valve replacement; aortic valve stenosis; cancer; computed tomography; incidental finding; malignancy; mortality