Comparison of Results of Transcatheter Aortic Valve Implantation in Patients With Versus Without Active Cancer.
The aim of this study was to evaluate postprocedural and midterm outcomes of transcatheter aortic valve implantation (TAVI) in patients with aortic stenosis and active cancer. From October 2013 to August 2015, a total of 749 patients undergoing TAVI using the Edwards Sapien XT prosthesis (Edwards Lifesciences, Irvine, California) were prospectively included in the OCEAN-TAVI registry from 8 Japanese centers. A total of 47 patients (44.7% men; median age 83 years) had active cancer. The transfemoral approach was implemented in 85.1% of patients in the cancer group and 78.1% in the noncancer group (p = 0.22). The occurrence of major vascular complication (4.3% vs 7.5%, p = 0.24), life-threatening bleeding (2.1% vs 7.1%, p = 0.15), and major bleeding (8.5% vs 13%, p = 0.38) was similar between the cancer and noncancer groups. No significant differences were observed regarding device success (100% vs 96.2%, p = 0.17) or 30-day survival (95.7% vs 97.3%, p = 0.38). No difference in midterm survival was found between the patients with cancer and without cancer (log-rank, p = 0.42), regardless of advanced or limited cancer (log-rank, p = 0.68). In a multivariable Cox proportional hazard regression analysis, cancer metastasis was one of the most significant predictors of late mortality (hazard ratio 4.73, 95% CI 1.12 to 20.0; p = 0.035). In conclusion, patients with cancer with severe aortic stenosis who underwent TAVI had similar acute outcomes and midterm survival rates compared with patients without cancer. Cancer metastasis was associated with increased mortality after TAVI.
Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan. Electronic address: yusuke0831@gmail.com.
Yusuke
Y
Watanabe
Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
Ken
K
Kozuma
Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
Hirofumi
H
Hioki
Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
Hideyuki
H
Kawashima
Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
Yugo
Y
Nara
Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
Akihisa
A
Kataoka
Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan.
Shinichi
S
Shirai
Department of Cardiology, Sendai Kousei Hospital, Miyagi, Japan.
Norio
N
Tada
Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan.
Motoharu
M
Araki
Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
Kensuke
K
Takagi
Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan.
Futoshi
F
Yamanaka
Department of Cardiology, Toyohashi Heart Center, Aichi, Japan; Department of Cardiology, Nagoya Heart Center, Aichi, Japan.
Masanori
M
Yamamoto
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Kentaro
K
Hayashida
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000601:surgery*; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D009026:Mortality; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000453:epidemiology* / Q000473:pathology; D011183:Postoperative Complications / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012042:Registries; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome