Transcatheter Aortic Valve Implantation in Oncology Patients with Aortic Stenosis

Background: Patients with active oncologic disease and severe aortic stenosis (AS) are often denied from surgical aortic valve replacement (AVR). Transcatheter AVR (TAVI) may be a better option for these patients, but was not yet systematically evaluated.

Methods: An international TAVI in Oncology Patients with AS (TOP AS) registry was designed to collect data on patients with cancer (excluding non-melanoma skin cancer) undergoing TAVI.

Results: Data were collected on 222 patients from 18 centers: age 78 ± 7 years, STS 5 ± 3%, 62% males. Each year between 2008 and 2016, the volume of cancer patients undergoing TAVI increased significantly among the centers participating. Most frequent types of cancer were gastrointestinal (22%), prostate (16%), breast (15%), hematologic (15%) and lung (11%). At TAVI day, 38% patients had stage 4 cancer and 29% received antineoplastic therapy. Compared with 659 patients without cancer, periprocedural complication rates were similar, excluding higher major bleeding in cancer patients (8.6% vs. 3.1%; p<0.001). Although 30 day mortality was similar, 1 year mortality was higher in cancer patients (15% vs. 9%; p=0.018), escalated along with cancer stage (p<0.001), with most deaths being non-cardiovascular and due to cancer (p<0.001). In a multivariable analysis, chemotherapy prior to TAVI was the strongest predictor of late mortality (hazard ratio 2.28, 95% CI 1.22 – 4.27; p=0.01) along with high STS score (p=0.032) and peripheral artery disease (p=0.028).

Conclusion: TAVI in patients with cancer have similar short-term but worse long-term outcome compared with patients without cancer. Yet, more than 4 of 5 patients were alive 1 year post TAVI. Among this cohort, mortality is largely due to cancer, and prior or concurrent chemotherapy is a strong predictor of mortality. These should be taken in consideration by the heart team in the decision-making process when evaluating patients for TAVI.