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Osawa T, Tajiri K, Hoshi T, Ieda M, Ishizu T. Impact of cancer in patients with aortic stenosis undergoing transcatheter aortic valve replacement: A systematic review and meta-analysis. Int J Cardiol Heart Vasc 2024; 52:101410. [PMID: 38650615 PMCID: PMC11033174 DOI: 10.1016/j.ijcha.2024.101410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/14/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
Background Owing to the minimally invasive nature of transcatheter aortic valve replacement (TAVR), TAVR seems to be preferred in patients with cancer; however, related research on the clinical efficacy and safety of TAVR in patients with cancer and severe aortic stenosis is limited, and conclusions are controversial. This study aimed to evaluate the clinical outcomes of patients with cancer who underwent TAVR. Method and results We conducted a systematic review and meta-analysis to investigate the clinical outcomes in patients with and without cancer who underwent TAVR. We systematically reviewed and analyzed 15 studies (195,658 patients) published in PubMed and Cochrane Library databases between January 2022 and January 2023. The primary outcomes were short-term (in-hospital or 30-day) and long-term (≥12 months) mortality. The prevalence of current or previous cancer in the patients undergoing TAVR was 19.8 % (38,695 patients). Patients with cancer had a lower risk of short-term mortality (odds ratio [OR] 0.69, 95 % confidence interval [CI] 0.61-0.77, P < 0.001) but a higher risk of long-term mortality (OR 1.54, 95 % CI 1.35-1.76, P < 0.001) than those without cancer. Patients with cancer had a lower incidence of postprocedural stroke and acute kidney injury but a higher incidence of pacemaker implantation than patients without cancer. Conclusions Patients with cancer undergoing TAVR have a good short-term prognosis and acceptable perioperative complications compared with patients without cancer. However, the long-term outcomes are contingent on cancer survival.
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Affiliation(s)
- Takumi Osawa
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Japan
- Department of Cardiology, Tsukuba Medical Center Hospital, Japan
- Department of Cardiology, National Cancer Center Hospital East, Japan
| | - Kazuko Tajiri
- Department of Cardiology, National Cancer Center Hospital East, Japan
- Tsukuba Life Science Innovation Program (T-LSI), School of Integrative and Global Majors (SIGMA), University of Tsukuba, Japan
| | - Tomoya Hoshi
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Japan
| | - Masaki Ieda
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Japan
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Tomoko Ishizu
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Japan
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Abstract
The prevalence of concurrent cancer and severe aortic stenosis (AS) is increasing due to an ageing population. In addition to shared traditional risk factors for AS and cancer, patients with cancer may be at increased risk for AS due to off-target effects of cancer-related therapy, such as mediastinal radiation therapy (XRT), as well as shared non-traditional pathophysiological mechanisms. Compared with surgical aortic valve replacement, major adverse events are generally lower in patients with cancer undergoing transcatheter aortic valve intervention (TAVI), especially in those with history of mediastinal XRT. Similar procedural and short-to-intermediate TAVI outcomes have been observed in patients with cancer as compared with no cancer, whereas long-term outcomes are dependent on cancer survival. Considerable heterogeneity exists between cancer subtypes and stage, with worse outcomes observed in those with active and advanced-stage disease as well as specific cancer subtypes. Procedural management in patients with cancer poses unique challenges and thus requires periprocedural expertise and close collaboration with the referring oncology team. The decision to ultimately pursue TAVI involves a multidisciplinary and holistic approach in assessing the appropriateness of intervention. Further clinical trial and registry studies are needed to better appreciate outcomes in this population.
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Affiliation(s)
- Douglas Leedy
- Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - David M Elison
- Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Francisco Farias
- Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Richard Cheng
- Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - James M McCabe
- Cardiology, University of Washington Medical Center, Seattle, Washington, USA
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Trimaille A, Matsushita K, Marchandot B, Carmona A, Hess S, Reydel A, Faucher L, Granier A, Mai TA, Diop B, Ohlmann P, Jesel L, Morel O. Outcomes of patients with active cancer undergoing transcatheter aortic valve replacement. Arch Cardiovasc Dis 2023:S1875-2136(23)00165-1. [PMID: 37758593 DOI: 10.1016/j.acvd.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Cardiovascular disease and cancer are the two leading causes of mortality worldwide, and their association presents a therapeutic challenge. Current data regarding the prognosis of active cancer in patients undergoing transcatheter aortic valve replacement are conflicting. AIM To determine the impact and prognosis of active cancer in transcatheter aortic valve replacement. METHODS All consecutive patients with severe aortic stenosis treated by transcatheter aortic valve replacement between February 2010 and May 2019 were enrolled in a prospective study. The cohort was divided according to the presence or absence of active cancer at baseline. The primary endpoint was all-cause mortality 1 year after the procedure. RESULTS A total of 1,125 patients were enrolled: 1,037 (92.2%) without and 88 (7.8%) with active cancer. The most frequent cancers were haematological (36.4%), breast (14.8%) and prostate (14.8%), with 79.5% of patients receiving curative treatment and 17.0% receiving palliative treatment. The 1-year mortality rate was higher in patients with active cancer (27.3% vs. 13.9%; P<0.01), mainly driven by non-cardiovascular causes. An increased cardiovascular mortality rate at 2 years was seen in patients with active cancer (27.5% vs. 15.0%; P=0.03) compared with a similar rate at 1-year follow-up. Active cancer was a strong predictor of 1-year all-cause mortality (hazard ratio 2.46, 95% confidence interval 1.19-4.68; P=0.02). Major/life-threatening bleeding events at 1 year were more frequent in patients with active cancer (P=0.02). CONCLUSIONS Among patients who undergo transcatheter aortic valve replacement, 1-year all-cause mortality is higher in those with active cancer. We also observed a trend towards increased long-term bleeding events in case of active cancer.
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Affiliation(s)
- Antonin Trimaille
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France; Inserm (French National Institute of Health and Medical Research), FMTS, Regenerative Nanomedicine, UMR 1260, 67000 Strasbourg, France
| | - Kensuke Matsushita
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France; Inserm (French National Institute of Health and Medical Research), FMTS, Regenerative Nanomedicine, UMR 1260, 67000 Strasbourg, France
| | - Benjamin Marchandot
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Adrien Carmona
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Sebastien Hess
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Antje Reydel
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Loic Faucher
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Amandine Granier
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Trung Anh Mai
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Bamba Diop
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Patrick Ohlmann
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France
| | - Laurence Jesel
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France; Inserm (French National Institute of Health and Medical Research), FMTS, Regenerative Nanomedicine, UMR 1260, 67000 Strasbourg, France
| | - Olivier Morel
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Nouvel Hôpital Civil, 67091 Strasbourg, France; Inserm (French National Institute of Health and Medical Research), FMTS, Regenerative Nanomedicine, UMR 1260, 67000 Strasbourg, France.
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Fujimoto Y, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Comparison of Outcomes of Elective Percutaneous Coronary Intervention between Complex and High-Risk Intervention in Indicated Patients (CHIP) versus Non-CHIP. J Atheroscler Thromb 2023; 30:1229-1241. [PMID: 36529503 PMCID: PMC10499455 DOI: 10.5551/jat.63956] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/31/2022] [Indexed: 09/05/2023] Open
Abstract
AIMS Complex and high-risk intervention in indicated patients (CHIP) is an emerging concept in the contemporary percutaneous coronary intervention (PCI). CHIP is known to consist three factors, namely, (1) patient factors, (2) complicated heart disease, and (3) complex PCI. However, it remains unclear whether additional CHIP factors further increase the incidence of complications in complex PCI. Thus, in this study, we aim to compare the incidence of complications among definite CHIP, possible CHIP, and non-CHIP in terms of complex PCI and to further investigate the association between CHIP and complications. METHODS The primary aim of this study was to determine the major complications in PCI. We included 989 PCI lesions and divided those into definite CHIP (n=140), possible CHIP (n=397), and the non-CHIP groups (n=452). RESULTS The incidence of major complications was noted to be the highest in the definite CHIP, followed by the possible CHIP, and lowest in the non-CHIP (p=0.001). The multivariate logistic regression analysis using a generalized estimating equation revealed definite CHIP (versus non-CHIP: odds ratio (OR) 2.099, 95% confidence interval (CI) 1.062-4.150, p=0.033) was significantly associated with major complications after controlling for confounding factors. Another multivariate logistic regression analysis revealed immunosuppressive drugs (OR 3.040, 95% CI 1.251-7.386, p=0.014), unstable hemodynamics (OR 5.753, 95% CI 1.217-27.201, p=0.027), and frailty (OR 2.039, 95% CI 1.108-3.751, p=0.022) were significantly associated with major complications among CHIP factors. CONCLUSIONS The incidence of major complications in complex PCI was determined to be the highest in the definite CHIP, followed by the possible CHIP and lowest in the non-CHIP. Thus, more attention should be given to the three components of CHIP to prevent major complications in complex PCI.
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Affiliation(s)
- Yudai Fujimoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Fujimoto Y, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Comparison of Long-Term Clinical Outcomes of Elective Percutaneous Coronary Intervention Between Complex and High-risk Intervention in Indicated Patients (CHIP) versus Non-CHIP. Am J Cardiol 2023; 194:1-8. [PMID: 36913903 DOI: 10.1016/j.amjcard.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 03/15/2023]
Abstract
Recently, there has been a growing interest in complex and high-risk intervention in indicated patients (CHIP) in the contemporary percutaneous coronary intervention (PCI). CHIP is composed of the following 3 factors: (1) patient factors, (2) complicated heart disease, and (3) complex PCI. However, there are few studies that investigated the long-term outcomes of CHIP-PCI. The purpose of this study was to compare the incidence of long-term major adverse cardiovascular events (MACEs) among the definite CHIP, possible CHIP, and non-CHIP groups in complex PCI. We included 961 patients and divided them into the definite CHIP (n = 129), the possible CHIP (n = 369), and the non-CHIP groups (n = 463). During the median follow-up duration of 573 days (quartile 1:226 days to quartile 3:1,165 days), a total of 189 MACE were observed. The incidence of MACE was highest in the definite CHIP group, followed by the possible CHIP group, and lowest in the non-CHIP group (p = 0.001). Definite CHIP (vs non-CHIP: odds ratio 3.558, 95% confidence interval 2.249 to 5.629, p <0.001) and possible CHIP (vs non-CHIP: odds ratio 2.260, 95% confidence interval 1.563 to 3.266, p <0.001) were significantly associated with MACE after controlling for confounding factors. Among CHIP factors, active malignancy, pulmonary disease, hemodialysis, unstable hemodynamics, left ventricular ejection fraction, and valvular disease were significantly associated with MACE. In conclusion, the incidence of MACE in complex PCI was highest in the definite CHIP group, followed by the possible CHIP group, and lowest in the non-CHIP group. The concept of CHIP should be recognized to predict the long-term MACE in patients who undergo complex PCI.
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Affiliation(s)
- Yudai Fujimoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Kojima Y, Higuchi R, Hagiya K, Saji M, Takamisawa I, Iguchi N, Takanashi S, Doi S, Okazaki S, Sato K, Tamura H, Takayama M, Ikeda T, Isobe M. Prognosis of patients with active cancer undergoing transcatheter aortic valve implantation: An insight from Japanese multicenter registry. IJC Heart & Vasculature 2022; 40:101045. [PMID: 35514877 PMCID: PMC9066355 DOI: 10.1016/j.ijcha.2022.101045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/23/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022]
Abstract
Background Malignancy is common in older adults undergoing transcatheter aortic valve implantation (TAVI), and may affect prognosis. The present study aimed to examine whether active cancer affects all-cause mortality rates among patients undergoing TAVI. Methods This retrospective study examined data from 1,114 consecutive patients treated between April 2010 and June 2019. Patients with life expectancy of <1 year due to non-cardiac causes were excluded. Results Active cancer was defined as cancer under treatment or cured within 1 year, and was recognized in 62 patients (5.6%) with (n = 17) and without (n = 45) metastases. In multivariate analysis, being female (hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.39–0.77, p < 0.001), body mass index (BMI) (HR = 0.92 per 1 kg/m2 increase, 95% CI 0.87–0.97, p = 0.001), New York Heart Association (NYHA) class III/IV (HR = 1.53, 95% CI 1.06–2.20, p = 0.022), atrial fibrillation (HR = 2.40, 95% CI 1.70–3.38, p < 0.001), albumin levels (HR = 0.41 per 1-g/dl, 95% CI 0.30–0.57, p < 0.001), and cancer metastasis (HR = 5.28, 95% CI 1.86–14.9, p = 0.001) were associated with all-cause mortality after TAVI. Conclusion In patients undergoing TAVI, being female, high BMI, NYHA class III/IV, atrial fibrillation, albumin levels, and cancer metastasis were factors associated with mortality. Meanwhile, active cancer without metastasis was not associated with increased mortality rates. These findings would help clinical decision-making by patients and physicians. Clinical trial registration: UMIN000031133.
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Song Y, Wang Y, Wang Z, Xu C, Dou J, Jiang T. Comparing Clinical Outcomes on Oncology Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:890082. [PMID: 35711365 PMCID: PMC9193798 DOI: 10.3389/fcvm.2022.890082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To compare the clinical outcomes of cancer and non-cancer patients with severe aortic stenosis (AS) after transcatheter aortic valve implantation (TAVI). Methods A computer-based search in PubMed, EMbase, The Cochrane Library, CBM, CNKI, and Wanfang databases from their date of inception to October 2021, together with reference screening, was performed to identify eligible clinical trials. Two reviewers independently screened the articles, extracted data, and evaluated their quality. Review Manger 5.3 and Stata 12.0 software were used for meta-analysis. Results The selected 11 cohort studies contained 182,645 patients, including 36,283 patients with cancer and 146,362 patients without cancer. The results of the meta-analysis showed that the 30-day mortality [OR = 0.68, 95%CI (0.63,0.74), I2= 0, P < 0.00001] of patients with cancer in the AS group was lower than those in the non-cancer group; 1-year mortality [OR = 1.49, 95%CI(1.19,1.88), I2= 58%, P = 0.0006] and late mortality [OR = 1.52, 95%CI(1.26,1.84), I2= 55%, P < 0.0001] of patients with cancer in the AS group was higher than those in the non-cancer group. The results of the meta-analysis showed that the stroke [OR = 0.77, 95%CI (0.72, 0.82), I2= 0, P < 0.00001] and the acute kidney injury [OR = 0.78, 95%CI (0.68, 0.90), I2= 77%, P = 0.0005] of patients with cancer in the AS group was lower than those in the non-cancer group. The results of the meta-analysis showed no statistical difference in cardiovascular mortality, bleeding events, myocardial infarction, vascular complication, and device success rate. Conclusion It is more effective and safer in patients with cancer with severe AS who were undergoing TAVI. However, compared with patients with no cancer, this is still high in terms of long-term mortality, and further study of the role of TAVI in patients with cancer with AS is necessary. Systematic Review Registration Identifier [INPLASY CRD: 202220009].
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Affiliation(s)
- Yumeng Song
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Medicine, Soochow University, Suzhou, China
| | - Yutong Wang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Medicine, Soochow University, Suzhou, China
| | - Zuoxiang Wang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Medicine, Soochow University, Suzhou, China
| | - Chang Xu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Medicine, Soochow University, Suzhou, China
| | - Jingshen Dou
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Medicine, Soochow University, Suzhou, China
| | - Tingbo Jiang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Tingbo Jiang
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Siddiqui MU, Yacob O, Junarta J, Pasha AK, Mookadam F, Mamas MA, Fischman DL. Mortality after transcatheter aortic valve replacement for aortic stenosis among patients with malignancy: a systematic review and meta-analysis. BMC Cardiovasc Disord 2022; 22:210. [PMID: 35538411 PMCID: PMC9088110 DOI: 10.1186/s12872-022-02651-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 04/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With advancements in cancer treatment, the life expectancy of oncology patients has improved. Thus, transcatheter aortic valve replacement (TAVR) may be considered as a feasible option for oncology patients with severe symptomatic aortic stenosis (AS). We aim to evaluate the difference in short- and long-term all-cause mortality in cancer and non-cancer patients treated with TAVR for severe AS. METHODS Medline, PubMed, and Cochrane Central Register of Controlled Trials were searched for relevant studies. Patients with cancer who underwent treatment with TAVR for severe AS were included and compared to an identical population without cancer. The primary endpoints were short- and long-term all-cause mortality. RESULTS Of 899 studies included, 8 met inclusion criteria. Cancer patients had significantly higher long-term all-cause mortality after TAVR when compared to patients without cancer (risk ratio [RR] 1.43; 95% confidence interval (CI) 1.26-1.62; P < 0.01). Four studies evaluated short-term mortality after TAVR and demonstrated no difference in it in patients with and without cancer (RR 0.72; 95% CI 0.47-1.08; P = 0.11). CONCLUSION Patients with cancer and severe AS have higher long-term all-cause mortality after TAVR. However, we found no difference in short-term all-cause mortality when comparing patients with and without cancer. The decision to perform TAVR in cancer patients should be individualized based on life expectancy and existing co-morbidities.
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Affiliation(s)
- Muhammad Umer Siddiqui
- Department of Internal Medicine, Thomas Jefferson University Hospitals, 833 Chestnut Street, Suite 701, Philadelphia, PA, 19107, USA.
| | - Omar Yacob
- Cardiovascular Medicine, MercyOne North Iowa Heart Center, Mason City, IA, USA
| | - Joey Junarta
- Department of Internal Medicine, Thomas Jefferson University Hospitals, 833 Chestnut Street, Suite 701, Philadelphia, PA, 19107, USA
| | - Ahmed K Pasha
- Cardiovascular Medicine, UHS Wilson Medical Center, Johnson City, NY, USA
| | - Farouk Mookadam
- Cardiovascular Medicine, Mayo Clinic Health System, Phoenix, AZ, USA
| | - Mamas A Mamas
- Cardiovascular Research Group, Center for Prognosis Research, Keele University, Keele, UK
| | - David L Fischman
- Cardiovascular Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Diaz-Arocutipa C, Torres-Valencia J, Zavaleta-Camacho G, Vicent L. Association Between Previous or Active Cancer and Clinical Outcomes in TAVR Patients: A Systematic Review and Meta-Analysis of 255,840 Patients. Front Cardiovasc Med 2021; 8:763557. [PMID: 34796218 PMCID: PMC8593236 DOI: 10.3389/fcvm.2021.763557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: It has been proposed that transcatheter aortic valve replacement (TAVR) may be an option for patients with cancer and severe aortic stenosis. We assessed the association between previous or active cancer and clinical outcomes in TAVR patients. Methods: We searched four electronic databases from inception to March 05, 2021. The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular mortality, myocardial infarction, stroke, acute kidney injury, pacemaker implantation, major bleeding, and vascular complications. All meta-analyses were performed using a random-effects model. Relative risks (RRs) and adjusted hazard ratios (aHRs) with their 95% confidence interval (95% CI) were pooled. Results: Thirteen cohort studies involving 255,840 patients were included. The time period for mortality ranged from inpatient to 10 years. Patients with active cancer had a higher risk of all-cause mortality using both crude (RR, 1.46; 95% CI, 1.13-1.88) and adjusted (aHR, 1.79; 95% CI, 1.43-2.25) estimates compared to non-cancer group. In contrast, the risk of cardiovascular mortality (RR, 1.26; 95% CI, 0.58-2.73), myocardial infarction (RR, 0.94; 95% CI, 0.34-2.57), stroke (RR, 0.90; 95% CI, 0.75-1.09), pacemaker implantation (RR, 0.87; 95% CI, 0.50-1.53), acute kidney injury (RR, 0.88; 95% CI, 0.74-1.04), major bleeding (RR, 1.15; 95% CI, 0.80-1.66), and vascular complications (RR, 0.96; 95% CI, 0.79-1.18) was similar between patients with or without cancer. Conclusion: Our review shows that TAVR patients with active cancer had an increased risk of all-cause mortality. No significant association with secondary outcomes was found.
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Affiliation(s)
- Carlos Diaz-Arocutipa
- Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru.,Programa de Atención Domiciliaria - EsSalud, Lima, Peru
| | - Javier Torres-Valencia
- Departamento de Cardiología, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru.,Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gabriela Zavaleta-Camacho
- Departamento de Cardiología, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru.,Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lourdes Vicent
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
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Karaduman BD, Ayhan H, Keleş T, Bozkurt E. Clinical outcomes after transcatheter aortic valve implantation in active cancer patients and cancer survivors. Turk Gogus Kalp Damar Cerrahisi Derg 2021; 29:45-51. [PMID: 33768980 DOI: 10.5606/tgkdc.dergisi.2021.20622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/23/2020] [Indexed: 12/03/2022]
Abstract
Background
In this study, we aimed to evaluate the clinical characteristics, perioperative, and mid-term outcomes of patients with severe symptomatic aortic stenosis and active cancer disease and cancer survivors undergoing transcatheter aortic valve implantation.
Methods
Between December 2011 and March 2019, a total of 550 patients (248 males, 302 females; mean age: 77.6±7.9 years; range, 46 to 103 years) who underwent transcatheter aortic valve implantation for severe symptomatic aortic stenosis in our center were retrospectively analyzed. Baseline demographic characteristics, cancer type, laboratory data, procedural data, and outcome data of the patients were collected. The primary outcome measure was all-cause mortality at 30 days and every six months up to maximally available follow-up. Follow-up was performed at 30 days, six months, and 12 months after the procedure and annually thereafter.
Results
Of the patients, 36 had a cancer diagnosis-active (n=10) or cured (n=26). The most common types of cancer were colorectal (16.6%), prostate (13.8%), leukemia (11.1%), and bladder (11.1%) cancers. Post-procedural complication rates were similar between the two groups. No mortality was observed in the cancer group at one month of follow-up. During follow-up, seven patients died within one year due to non-cardiac reasons. Although mortality at one year was higher in cancer patients, it did not reach statistical significance (23.3% vs. 11.6%, respectively; p=0.061). The estimated cumulative survival rate was 71.0% in the non-cancer group and 58.3% in the cancer group. The multivariate Cox regression analysis revealed that cancer was independently associated with cumulative mortality after adjusting for age, sex, body mass index, and atrial fibrillation (p=0.008).
Conclusion
Our study results show that transcatheter aortic valve implantation is safe and feasible in active cancer patients and cancer survivors with similar short-term and mid-term mortality and procedure-related complication rates, compared to non-cancer patients.
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Takagi K, Arinaga K, Takaseya T, Otsuka H, Shojima T, Shintani Y, Kono T, Zaima Y, Kikusaki S, Saku K, Oryoji A, Tayama E. Clinical outcome of cardiac surgery in patients with remitted or active hepatocellular carcinoma. Surg Today 2021; 51:1456-63. [PMID: 33555435 DOI: 10.1007/s00595-021-02239-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Hepatocellular carcinoma (HCC) is one of the most common primary cancers worldwide. HCC has unique characteristics such as co-existing chronic liver damage and a high recurrence rate. A negative impact on the surgical outcome due to these backgrounds could be expected. We aimed to evaluate the clinical outcomes of cardiac surgery in these patients. METHODS Between January 2000 and December 2019, 16 patients with remitted cancer and 5 patients with active HCC who underwent open heart surgery were studied. The clinical data were retrospectively evaluated from hospital records. Follow-up information was collected via telephone interviews. RESULTS The major cause of HCC was viral hepatitis. Eighteen patients (86%) were classified as having Child-Pugh class A cirrhosis. The mean model of end-stage liver disease (MELD) score was 7.2 ± 5.2. There was no 30-day mortality. During follow-up, 11 patients died due to HCC. The 1-, 3-, and 5-year survival rates were 80.0, 42.5, and 22.3%, respectively. A univariate analysis identified a higher preoperative MELD score and lower serum cholinesterase levels as prognostic factors for long-term survival. CONCLUSION We could safely perform cardiac surgery in selected patients with remitted and active HCC. The postoperative life expectancy of these patients was limited but acceptable.
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Biancari F. Lack of standard definition of active cancer in patients undergoing cardiovascular interventions. Int J Cardiol 2020; 327:175. [PMID: 33259875 DOI: 10.1016/j.ijcard.2020.11.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/20/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland; Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland; Department of Surgery, University of Turku, Turku, Finland.
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Westreich R, Abramowitz Y. Cancer in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement: Is it malignant or benign? Int J Cardiol 2020; 315:90-91. [PMID: 32430213 DOI: 10.1016/j.ijcard.2020.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Roi Westreich
- Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Yigal Abramowitz
- Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
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Zafar MR, Mustafa SF, Miller TW, Alkhawlani T, Sharma UC. Outcomes after transcatheter aortic valve replacement in cancer survivors with prior chest radiation therapy: a systematic review and meta-analysis. Cardiooncology 2020; 6:8. [PMID: 32685198 PMCID: PMC7359474 DOI: 10.1186/s40959-020-00062-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/02/2020] [Indexed: 12/21/2022]
Abstract
Background Cancer survivors with prior chest radiation therapy (C-XRT) frequently present with aortic stenosis (AS) as the first manifestation of radiation-induced heart disease. They are considered high-risk for surgical valve replacement. Transcatheter aortic valve replacement (TAVR) is as an attractive option for this patient population but the outcomes are not well established in major clinical trials. The authors performed a systemic review and meta-analysis of clinical studies for the outcomes after TAVR in cancer survivors with prior C-XRT. Methods Online databases were searched from inception to April 2020 for studies evaluating the outcomes of TAVR in patients with and without C-XRT. We analyzed the pooled estimates (with their 95% confidence intervals) of the odds ratio (OR) for the all-cause mortality at 30-day and 1-year follow-ups, 4-point safety outcomes (stroke, major bleed, access-related vascular complications and need for a pacemaker), a 2-point efficacy outcome (mean aortic valve gradient and left ventricular ejection fraction) and worsening of congestive heart failure (CHF). Four studies were included following 2054 patients with and without prior C-XRT exposure (164 patients and 1890 patients respectively). Results The C-XRT group had similar 30-day mortality compared to the control group (OR 1.29, 95% CI 0.64 to 2.58, p = 0.48). The 1-year mortality was higher in the C-XRT group (OR 1.97, CI 1.15 to 3.39, p = 0.01). Apart from higher congestive heart failure (CHF) exacerbation in the C-XRT group (OR 2.03, CI 1.36 to 3.04, p = 0.0006), TAVR resulted in similar safety and efficacy outcomes in both groups. Conclusion TAVR in the C-XRT group has similar 30-day mortality, safety, and efficacy outcomes compared to the control group; however, they have higher 1-year mortality and CHF exacerbation. Including an oncologist to the cardiology team who considers cancer stage in the decision-making process and applying additional preoperative scores such as frailty indices may refine the risk assessment for these patients. The quality of analyzed data is modest, warranting randomized trials to assess the true benefits of TAVR in these patients.
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Affiliation(s)
- Meer Rabeel Zafar
- Department of Medicine, Division Cardiology, Jacob's School of Medicine and Biomedical Sciences, 875 Ellicott Street, Suite 7030, Buffalo, New York, 14203 USA
| | | | - Timothy W Miller
- Department of Medicine, Division Cardiology, Jacob's School of Medicine and Biomedical Sciences, 875 Ellicott Street, Suite 7030, Buffalo, New York, 14203 USA
| | - Talal Alkhawlani
- Department of Medicine, Division Cardiology, Jacob's School of Medicine and Biomedical Sciences, 875 Ellicott Street, Suite 7030, Buffalo, New York, 14203 USA
| | - Umesh C Sharma
- Department of Medicine, Division Cardiology, Jacob's School of Medicine and Biomedical Sciences, 875 Ellicott Street, Suite 7030, Buffalo, New York, 14203 USA
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