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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.
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      References

        • Bach D.S.
        • Cimino N.
        • Deeb G.M.
        Unoperated patients with severe aortic stenosis.
        J Am Coll Cardiol. 2007; 50: 2018-2019
        • Yusuf S.W.
        • Sarfaraz A.
        • Durand J.B.
        • Swafford J.
        • Daher I.N.
        Management and outcomes of severe aortic stenosis in cancer patients.
        Am Heart J. 2011; 161: 1125-1132
        • Samuels L.E.
        • Kaufman M.S.
        • Morris R.J.
        • Styler M.
        • Brockman S.K.
        Open heart surgery in patients with chronic lymphocytic leukemia.
        Leuk Res. 1999; 23: 71-75
        • Ascione R.
        • Williams S.
        • Lloyd C.T.
        • Sundaramoorthi T.
        • Pitsis A.A.
        • Angelini G.D.
        Reduced postoperative blood loss and transfusion requirement after beating-heart coronary operations: a prospective randomized study.
        J Thorac Cardiovasc Surg. 2001; 121: 689-696
        • Despotis G.J.
        • Filos K.S.
        • Zoys T.N.
        • Hogue Jr., C.W.
        • Spitznagel E.
        • Lappas D.G.
        Factors associated with excessive postoperative blood loss and hemostatic transfusion requirements: a multivariate analysis in cardiac surgical patients.
        Anesth Analg. 1996; 82: 13-21
        • Scott B.H.
        • Seifert F.C.
        • Glass P.S.
        • Grimson R.
        Blood use in patients undergoing coronary artery bypass surgery: impact of cardiopulmonary bypass pump, hematocrit, gender, age, and body weight.
        Anesth Analg. 2003; 97 (table of contents): 958-963
        • Khuri S.F.
        • Wolfe J.A.
        • Josa M.
        • Axford T.C.
        • Szymanski I.
        • Assousa S.
        • Ragno G.
        • Patel M.
        • Silverman A.
        • Park M.
        Hematologic changes during and after cardiopulmonary bypass and their relationship to the bleeding time and nonsurgical blood loss.
        J Thorac Cardiovasc Surg. 1992; 104: 94-107
        • Woodman R.C.
        • Harker L.A.
        Bleeding complications associated with cardiopulmonary bypass.
        Blood. 1990; 76: 1680-1697
        • Zhu Y.
        • Choi S.H.
        • Shah K.
        Multifunctional receptor-targeting antibodies for cancer therapy.
        Lancet Oncol. 2015; 16: e543-e554
        • Nishimura R.A.
        • Otto C.M.
        • Bonow R.O.
        • Carabello B.A.
        • Erwin 3rd, J.P.
        • Guyton R.A.
        • O'Gara P.T.
        • Ruiz C.E.
        • Skubas N.J.
        • Sorajja P.
        • Sundt 3rd, T.M.
        • Thomas J.D.
        2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines.
        J Am Coll Cardiol. 2014; 63: e57-e185
        • Van Mieghem N.M.
        • van der Boon R.M.
        • Nuis R.J.
        • Schultz C.
        • van Geuns R.J.
        • Serruys P.W.
        • Kappetein A.P.
        • van Domburg R.T.
        • de Jaegere P.P.
        Cause of death after transcatheter aortic valve implantation.
        Catheter Cardiovasc Interv. 2014; 83: E277-E282
        • Kogoj P.
        • Devjak R.
        • Bunc M.
        Balloon aortic valvuloplasty (BAV) as a bridge to aortic valve replacement in cancer patients who require urgent non-cardiac surgery.
        Radiol Oncol. 2014; 48: 62-66
        • Poldermans D.
        • Bax J.J.
        • Boersma E.
        • De Hert S.
        • Eeckhout E.
        • Fowkes G.
        • Gorenek B.
        • Hennerici M.G.
        • Iung B.
        • Kelm M.
        • Kjeldsen K.P.
        • Kristensen S.D.
        • Lopez-Sendon J.
        • Pelosi P.
        • Philippe F.
        • Pierard L.
        • Ponikowski P.
        • Schmid J.P.
        • Sellevold O.F.
        • Sicari R.
        • Van den Berghe G.
        • Vermassen F.
        Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery.
        Eur Heart J. 2009; 30: 2769-2812
        • Vahanian A.
        • Alfieri O.
        • Andreotti F.
        • Antunes M.J.
        • Baron-Esquivias G.
        • Baumgartner H.
        • Borger M.A.
        • Carrel T.P.
        • De Bonis M.
        • Evangelista A.
        • Falk V.
        • Iung B.
        • Lancellotti P.
        • Pierard L.
        • Price S.
        • Schafers H.J.
        • Schuler G.
        • Stepinska J.
        • Swedberg K.
        • Takkenberg J.
        • Von Oppell U.O.
        • Windecker S.
        • Zamorano J.L.
        • Zembala M.
        Guidelines on the management of valvular heart disease (version 2012).
        Eur Heart J. 2012; 33: 2451-2496
        • Fleisher L.A.
        • Beckman J.A.
        • Brown K.A.
        • Calkins H.
        • Chaikof E.
        • Fleischmann K.E.
        • Freeman W.K.
        • Froehlich J.B.
        • Kasper E.K.
        • Kersten J.R.
        • Riegel B.
        • Robb J.F.
        • Smith Jr., S.C.
        • Jacobs A.K.
        • Adams C.D.
        • Anderson J.L.
        • Antman E.M.
        • Buller C.E.
        • Creager M.A.
        • Ettinger S.M.
        • Faxon D.P.
        • Fuster V.
        • Halperin J.L.
        • Hiratzka L.F.
        • Hunt S.A.
        • Lytle B.W.
        • Nishimura R.
        • Ornato J.P.
        • Page R.L.
        • Tarkington L.G.
        • Yancy C.W.
        ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (writing committee to revise the 2002 guidelines on perioperative cardiovascular evaluation for noncardiac surgery): developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery.
        Circulation. 2007; 116: e418-e499