title: Thoracic Malignancies and Pulmonary Nodules in Patients under Evaluation for Transcatheter Aortic Valve Implantation (TAVI): Incidence, Follow Up and Possible Impact on Treatment Decision.
abstract: Transcatheter aortic valve implantation (TAVI) has become the treatment of choice in patients with severe aortic valve stenosis who are not eligible for operative replacement and an alternative for those with high surgical risk. Due to high age and smoking history in a high proportion of TAVI patients, suspicious findings are frequently observed in pre-procedural chest computer tomography (CCT).
  
  
  
  CCT scans of 484 consecutive patients undergoing TAVI were evaluated for incidentally discovered solitary pulmonary nodules (SPN).
  
  
  
  In the entire study population, SPN ≥ 5 mm were found in 87 patients (18%). These patients were compared to 150 patients who were incidentally collected from the 397 patients without SPN or with SPN < 5 mm (control group). After a median follow-up of 455 days, lung cancer was diagnosed in only two patients. Neither SPN ≥ 5 mm (p = 0.579) nor SPN > 8 mm (p = 0.328) were significant predictors of overall survival.
  
  
  
  Despite the high prevalence of SPNs in this single center TAVI cohort lung cancer incidence at midterm follow-up seems to be low. Thus, aggressive diagnostic approaches for incidentally discovered SPN during TAVI evaluation should not delay the treatment of aortic stenosis. Unless advanced thoracic malignancy is obvious, the well documented reduction of morbidity and mortality by TAVI outweighs potentially harmful delays regarding further diagnostics. Standard guideline-approved procedure for SPN can be safely performed after TAVI.
authors.affiliation: Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany.
authors.forename: Lars Henning
authors.identifier: 0000-0001-7931-0260
authors.initials: LH
authors.lastname: Schmidt
authors.affiliation: Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Vietmeier
authors.affiliation: Department of Cardiovascular Medicine, Division of Adult Congenital and Valvular Heart Disease, University Hospital Münster, Münster, Germany.
authors.forename: Gerrit
authors.initials: G
authors.lastname: Kaleschke
authors.affiliation: Department of Clinical Radiology, University Hospital of Münster, Münster, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schülke
authors.affiliation: Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-Universität Münster, Münster, Germany.
authors.forename: Dennis
authors.initials: D
authors.lastname: Görlich
authors.affiliation: Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schliemann
authors.affiliation: Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Kessler
authors.affiliation: Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany.
authors.forename: Arik Bernard
authors.initials: AB
authors.lastname: Schulze
authors.affiliation: Department of Clinical Radiology, University Hospital of Münster, Münster, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Buerke
authors.affiliation: Pulmonary Division, Department of Medicine III, Johannes Gutenberg University Medical Center, Mainz, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kuemmel
authors.affiliation: Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Thrull
authors.affiliation: Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Wiewrodt
authors.affiliation: Department of Cardiovascular Medicine, Division of Adult Congenital and Valvular Heart Disease, University Hospital Münster, Münster, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Baumgartner
authors.affiliation: Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany.
authors.forename: Wolfgang E
authors.initials: WE
authors.lastname: Berdel
authors.affiliation: Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Mohr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D008175:Lung Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D003074:Solitary Pulmonary Nodule / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D013318:Stroke Volume; D016019:Survival Analysis; D013899:Thoracic Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome