Transcatheter Aortic Valve Replacement in Oncology Patients With Severe Aortic Stenosis

Uri Landes; Zaza Iakobishvili; Daniella Vronsky; Oren Zusman; Alon Barsheshet; Ronen Jaffe; Ayman Jubran; Sung Han Yoon; Raj R. Makkar; Maurizio Taramasso; Marco Russo; Francesco Maisano; Jan Malte Sinning; Jasmin Shamekhi; Luigi Biasco; Giovanni Pedrazzini; Marco Moccetti; Azeem Latib; Matteo Pagnesi; Antonio Colombo; Corrado Tamburino; Paolo D' Arrigo; Stephan Windecker; Thomas Pilgrim; Didier Tchetche; Chiara De Biase; Mayra Guerrero; Omer Iftikhar; Johan Bosmans; Edo Bedzra; Danny Dvir; Darren Mylotte; Horst Sievert; Yusuke Watanabe; Lars Søndergaard; Hanna Dagnegård; Pablo Codner; Susheel Kodali; Martin Leon; Ran Kornowski

doi:10.1016/j.jcin.2018.10.026

Transcatheter Aortic Valve Replacement in Oncology Patients With Severe Aortic Stenosis

Uri Landes, Zaza Iakobishvili, Daniella Vronsky, Oren Zusman, Alon Barsheshet, Ronen Jaffe, Ayman Jubran, Sung Han Yoon, Raj R. Makkar, Maurizio Taramasso, Marco Russo, Francesco Maisano, Jan Malte Sinning, Jasmin Shamekhi, Luigi Biasco, Giovanni Pedrazzini, Marco Moccetti, Azeem Latib, Matteo Pagnesi, Antonio ColomboCorrado Tamburino, Paolo D' Arrigo, Stephan Windecker, Thomas Pilgrim, Didier Tchetche, Chiara De Biase, Mayra Guerrero, Omer Iftikhar, Johan Bosmans, Edo Bedzra, Danny Dvir, Darren Mylotte, Horst Sievert, Yusuke Watanabe, Lars Søndergaard, Hanna Dagnegård, Pablo Codner, Susheel Kodali, Martin Leon, Ran Kornowski

Research output: Contribution to journal › Article › peer-review

57 Scopus citations

Abstract

Objectives: The authors sought to collect data on contemporary practice and outcome of transcatheter aortic valve replacement (TAVR) in oncology patients with severe aortic stenosis (AS). Background: Oncology patients with severe AS are often denied valve replacement. TAVR may be an emerging treatment option. Methods: A worldwide registry was designed to collect data on patients who undergo TAVR while having active malignancy. Data from 222 cancer patients from 18 TAVR centers were compared versus 2,522 “no-cancer” patients from 5 participating centers. Propensity-score matching was performed to further adjust for bias. Results: Cancer patients’ age was 78.8 ± 7.5 years, STS score 4.9 ± 3.4%, 62% men. Most frequent cancers were gastrointestinal (22%), prostate (16%), breast (15%), hematologic (15%), and lung (11%). At the time of TAVR, 40% had stage 4 cancer. Periprocedural complications were comparable between the groups. Although 30-day mortality was similar, 1-year mortality was higher in cancer patients (15% vs. 9%; p < 0.001); one-half of the deaths were due to neoplasm. Among patients who survived 1 year after the TAVR, one-third were in remission/cured from cancer. Progressive malignancy (stage III to IV) was a strong mortality predictor (hazard ratio: 2.37; 95% confidence interval: 1.74 to 3.23; p < 0.001), whereas stage I to II cancer was not associated with higher mortality compared with no-cancer patients. Conclusions: TAVR in cancer patients is associated with similar short-term but worse long-term prognosis compared with patients without cancer. Among this cohort, mortality is largely driven by cancer, and progressive malignancy is a strong mortality predictor. Importantly, 85% of the patients were alive at 1 year, one-third were in remission/cured from cancer.

Original language	English (US)
Pages (from-to)	78-86
Number of pages	9
Journal	JACC: Cardiovascular Interventions
Volume	12
Issue number	1
DOIs	https://doi.org/10.1016/j.jcin.2018.10.026
State	Published - Jan 14 2019
Externally published	Yes

Keywords

AS
TAVR
aortic stenosis
cancer
malignancy
transcatheter aortic valve replacement

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jcin.2018.10.026

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Landes, U., Iakobishvili, Z., Vronsky, D., Zusman, O., Barsheshet, A., Jaffe, R., Jubran, A., Yoon, S. H., Makkar, R. R., Taramasso, M., Russo, M., Maisano, F., Sinning, J. M., Shamekhi, J., Biasco, L., Pedrazzini, G., Moccetti, M., Latib, A., Pagnesi, M., ... Kornowski, R. (2019). Transcatheter Aortic Valve Replacement in Oncology Patients With Severe Aortic Stenosis. JACC: Cardiovascular Interventions, 12(1), 78-86. https://doi.org/10.1016/j.jcin.2018.10.026

Landes, U, Iakobishvili, Z, Vronsky, D, Zusman, O, Barsheshet, A, Jaffe, R, Jubran, A, Yoon, SH, Makkar, RR, Taramasso, M, Russo, M, Maisano, F, Sinning, JM, Shamekhi, J, Biasco, L, Pedrazzini, G, Moccetti, M, Latib, A, Pagnesi, M, Colombo, A, Tamburino, C, D' Arrigo, P, Windecker, S, Pilgrim, T, Tchetche, D, De Biase, C, Guerrero, M, Iftikhar, O, Bosmans, J, Bedzra, E, Dvir, D, Mylotte, D, Sievert, H, Watanabe, Y, Søndergaard, L, Dagnegård, H, Codner, P, Kodali, S, Leon, M & Kornowski, R 2019, 'Transcatheter Aortic Valve Replacement in Oncology Patients With Severe Aortic Stenosis', JACC: Cardiovascular Interventions, vol. 12, no. 1, pp. 78-86. https://doi.org/10.1016/j.jcin.2018.10.026

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title = "Transcatheter Aortic Valve Replacement in Oncology Patients With Severe Aortic Stenosis",

abstract = "Objectives: The authors sought to collect data on contemporary practice and outcome of transcatheter aortic valve replacement (TAVR) in oncology patients with severe aortic stenosis (AS). Background: Oncology patients with severe AS are often denied valve replacement. TAVR may be an emerging treatment option. Methods: A worldwide registry was designed to collect data on patients who undergo TAVR while having active malignancy. Data from 222 cancer patients from 18 TAVR centers were compared versus 2,522 “no-cancer” patients from 5 participating centers. Propensity-score matching was performed to further adjust for bias. Results: Cancer patients{\textquoteright} age was 78.8 ± 7.5 years, STS score 4.9 ± 3.4%, 62% men. Most frequent cancers were gastrointestinal (22%), prostate (16%), breast (15%), hematologic (15%), and lung (11%). At the time of TAVR, 40% had stage 4 cancer. Periprocedural complications were comparable between the groups. Although 30-day mortality was similar, 1-year mortality was higher in cancer patients (15% vs. 9%; p < 0.001); one-half of the deaths were due to neoplasm. Among patients who survived 1 year after the TAVR, one-third were in remission/cured from cancer. Progressive malignancy (stage III to IV) was a strong mortality predictor (hazard ratio: 2.37; 95% confidence interval: 1.74 to 3.23; p < 0.001), whereas stage I to II cancer was not associated with higher mortality compared with no-cancer patients. Conclusions: TAVR in cancer patients is associated with similar short-term but worse long-term prognosis compared with patients without cancer. Among this cohort, mortality is largely driven by cancer, and progressive malignancy is a strong mortality predictor. Importantly, 85% of the patients were alive at 1 year, one-third were in remission/cured from cancer.",

keywords = "AS, TAVR, aortic stenosis, cancer, malignancy, transcatheter aortic valve replacement",

author = "Uri Landes and Zaza Iakobishvili and Daniella Vronsky and Oren Zusman and Alon Barsheshet and Ronen Jaffe and Ayman Jubran and Yoon, {Sung Han} and Makkar, {Raj R.} and Maurizio Taramasso and Marco Russo and Francesco Maisano and Sinning, {Jan Malte} and Jasmin Shamekhi and Luigi Biasco and Giovanni Pedrazzini and Marco Moccetti and Azeem Latib and Matteo Pagnesi and Antonio Colombo and Corrado Tamburino and {D' Arrigo}, Paolo and Stephan Windecker and Thomas Pilgrim and Didier Tchetche and {De Biase}, Chiara and Mayra Guerrero and Omer Iftikhar and Johan Bosmans and Edo Bedzra and Danny Dvir and Darren Mylotte and Horst Sievert and Yusuke Watanabe and Lars S{\o}ndergaard and Hanna Dagneg{\aa}rd and Pablo Codner and Susheel Kodali and Martin Leon and Ran Kornowski",

note = "Publisher Copyright: {\textcopyright} 2019 American College of Cardiology Foundation",

year = "2019",

month = jan,

day = "14",

doi = "10.1016/j.jcin.2018.10.026",

language = "English (US)",

volume = "12",

pages = "78--86",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

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TY - JOUR

T1 - Transcatheter Aortic Valve Replacement in Oncology Patients With Severe Aortic Stenosis

AU - Landes, Uri

AU - Iakobishvili, Zaza

AU - Vronsky, Daniella

AU - Zusman, Oren

AU - Barsheshet, Alon

AU - Jaffe, Ronen

AU - Jubran, Ayman

AU - Yoon, Sung Han

AU - Makkar, Raj R.

AU - Taramasso, Maurizio

AU - Russo, Marco

AU - Maisano, Francesco

AU - Sinning, Jan Malte

AU - Shamekhi, Jasmin

AU - Biasco, Luigi

AU - Pedrazzini, Giovanni

AU - Moccetti, Marco

AU - Latib, Azeem

AU - Pagnesi, Matteo

AU - Colombo, Antonio

AU - Tamburino, Corrado

AU - D' Arrigo, Paolo

AU - Windecker, Stephan

AU - Pilgrim, Thomas

AU - Tchetche, Didier

AU - De Biase, Chiara

AU - Guerrero, Mayra

AU - Iftikhar, Omer

AU - Bosmans, Johan

AU - Bedzra, Edo

AU - Dvir, Danny

AU - Mylotte, Darren

AU - Sievert, Horst

AU - Watanabe, Yusuke

AU - Søndergaard, Lars

AU - Dagnegård, Hanna

AU - Codner, Pablo

AU - Kodali, Susheel

AU - Leon, Martin

AU - Kornowski, Ran

PY - 2019/1/14

Y1 - 2019/1/14

N2 - Objectives: The authors sought to collect data on contemporary practice and outcome of transcatheter aortic valve replacement (TAVR) in oncology patients with severe aortic stenosis (AS). Background: Oncology patients with severe AS are often denied valve replacement. TAVR may be an emerging treatment option. Methods: A worldwide registry was designed to collect data on patients who undergo TAVR while having active malignancy. Data from 222 cancer patients from 18 TAVR centers were compared versus 2,522 “no-cancer” patients from 5 participating centers. Propensity-score matching was performed to further adjust for bias. Results: Cancer patients’ age was 78.8 ± 7.5 years, STS score 4.9 ± 3.4%, 62% men. Most frequent cancers were gastrointestinal (22%), prostate (16%), breast (15%), hematologic (15%), and lung (11%). At the time of TAVR, 40% had stage 4 cancer. Periprocedural complications were comparable between the groups. Although 30-day mortality was similar, 1-year mortality was higher in cancer patients (15% vs. 9%; p < 0.001); one-half of the deaths were due to neoplasm. Among patients who survived 1 year after the TAVR, one-third were in remission/cured from cancer. Progressive malignancy (stage III to IV) was a strong mortality predictor (hazard ratio: 2.37; 95% confidence interval: 1.74 to 3.23; p < 0.001), whereas stage I to II cancer was not associated with higher mortality compared with no-cancer patients. Conclusions: TAVR in cancer patients is associated with similar short-term but worse long-term prognosis compared with patients without cancer. Among this cohort, mortality is largely driven by cancer, and progressive malignancy is a strong mortality predictor. Importantly, 85% of the patients were alive at 1 year, one-third were in remission/cured from cancer.

AB - Objectives: The authors sought to collect data on contemporary practice and outcome of transcatheter aortic valve replacement (TAVR) in oncology patients with severe aortic stenosis (AS). Background: Oncology patients with severe AS are often denied valve replacement. TAVR may be an emerging treatment option. Methods: A worldwide registry was designed to collect data on patients who undergo TAVR while having active malignancy. Data from 222 cancer patients from 18 TAVR centers were compared versus 2,522 “no-cancer” patients from 5 participating centers. Propensity-score matching was performed to further adjust for bias. Results: Cancer patients’ age was 78.8 ± 7.5 years, STS score 4.9 ± 3.4%, 62% men. Most frequent cancers were gastrointestinal (22%), prostate (16%), breast (15%), hematologic (15%), and lung (11%). At the time of TAVR, 40% had stage 4 cancer. Periprocedural complications were comparable between the groups. Although 30-day mortality was similar, 1-year mortality was higher in cancer patients (15% vs. 9%; p < 0.001); one-half of the deaths were due to neoplasm. Among patients who survived 1 year after the TAVR, one-third were in remission/cured from cancer. Progressive malignancy (stage III to IV) was a strong mortality predictor (hazard ratio: 2.37; 95% confidence interval: 1.74 to 3.23; p < 0.001), whereas stage I to II cancer was not associated with higher mortality compared with no-cancer patients. Conclusions: TAVR in cancer patients is associated with similar short-term but worse long-term prognosis compared with patients without cancer. Among this cohort, mortality is largely driven by cancer, and progressive malignancy is a strong mortality predictor. Importantly, 85% of the patients were alive at 1 year, one-third were in remission/cured from cancer.

KW - AS

KW - TAVR

KW - aortic stenosis

KW - cancer

KW - malignancy

KW - transcatheter aortic valve replacement

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Transcatheter Aortic Valve Replacement in Oncology Patients With Severe Aortic Stenosis

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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