Harrington Heart and Vascular Institute Case Western Reserve University Cleveland OH.
Cardio-Oncology Program Division of Cardiology Ohio State University Columbus OH.
J Am Heart Assoc. 2020 Jan 21;9(2):e014248. doi: 10.1161/JAHA.119.014248.
Background Patients with cancer and severe aortic stenosis are often ineligible for surgical aortic valve replacement (SAVR). Patients with cancer may likely benefit from emerging transcatheter aortic valve replacement (TAVR), given its minimally invasive nature. Methods and Results The US-based National Inpatient Sample was queried between 2012 and 2015 using (), codes to identify all hospitalized adults (aged ≥50 years), who had a primary diagnosis of aortic stenosis. We examined the effect modification of cancer on the relative use rate, outcomes, and dispositions associated with propensity-matched cohort TAVR versus SAVR. Overall, 47 295 TAVRs (22.6% comorbid cancer) and 113 405 SAVRs (15.2% comorbid cancer) were performed among admissions with aortic stenosis between 2012 and 2015. In the year 2015, patients with cancer saw relatively higher rates of TAVR use compared with SAVR (relative use rate versus relative use rate, 67.8% versus 57.2%; <0.0001). Among patients with cancer, TAVR was associated with lower odds of acute kidney injury (odds ratio, 0.64; 95% CI, 0.54-0.75) and major bleeding (odds ratio, 0.44; 95% CI, 0.38-0.51]), with no differences in in-hospital mortality and stroke compared with SAVR. In addition, TAVR was associated with higher odds of home discharge (odds ratio, 1.92; 95% CI, 1.68-2.19) compared with SAVR among patients with cancer. Lower risk of acute kidney injury was noted in cancer versus noncancer (<0.001) undergoing TAVR versus SAVR in effect modification analysis. Conclusions TAVR use has increased irrespective of cancer status, with a greater increase in cancer versus noncancer. In patients with cancer, there was an association of TAVR with lower periprocedural complications and better disposition when compared with patients undergoing SAVR.
患有癌症和严重主动脉瓣狭窄的患者通常不符合主动脉瓣置换术（SAVR）的条件。鉴于经导管主动脉瓣置换术（TAVR）的微创特性，患有癌症的患者可能会从中受益。
使用（）在美国基于国家住院患者样本数据库中进行了 2012 年至 2015 年的查询，以确定所有患有主动脉瓣狭窄的住院成年患者（年龄≥50 岁）的主要诊断。我们研究了癌症对倾向匹配队列 TAVR 与 SAVR 相关的相对使用率、结局和处置的影响修饰作用。总体而言，2012 年至 2015 年期间，主动脉瓣狭窄住院患者中进行了 47295 例 TAVR（22.6%合并癌症）和 113405 例 SAVR（15.2%合并癌症）。2015 年，与 SAVR 相比，患有癌症的患者接受 TAVR 的相对比例相对较高（相对使用率比，67.8%比 57.2%；<0.0001）。在患有癌症的患者中，TAVR 与急性肾损伤（比值比，0.64；95%置信区间，0.54-0.75）和大出血（比值比，0.44；95%置信区间，0.38-0.51）的几率较低，与 SAVR 相比，院内死亡率和卒中没有差异。此外，与 SAVR 相比，患有癌症的患者 TAVR 出院回家的几率更高（比值比，1.92；95%置信区间，1.68-2.19）。在 TAVR 与 SAVR 的效应修饰分析中，与非癌症患者相比，癌症患者的急性肾损伤风险降低（<0.001）。
无论癌症状态如何，TAVR 的使用都有所增加，癌症患者的增加幅度大于非癌症患者。在患有癌症的患者中，与接受 SAVR 的患者相比，TAVR 与围手术期并发症发生率较低和更好的处置有关。
