Bendary Ahmed, Ramzy Ahmed, Bendary Mohamed, Salem Mohamed
Cardiology, Benha University Faculty of Medicine, Benha, Egypt.
Biostatisitcs, National Cancer Institute, Cairo University, Cairo, Egypt.
Open Heart. 2020 Mar 11;7(1):e001131. doi: 10.1136/openhrt-2019-001131. eCollection 2020.
Patients with severe aortic stenosis and concomitant active cancer (AC) are considered high-risk patients and usually are not allowed to undergo surgical valve replacement. Transcatheter aortic valve replacement (TAVR) may be an attractive option for them; however, little is known about the outcomes of TAVR in this subset of complex patients.
In this meta-analysis, Medline, Cochrane Library and Scopus databases were searched (anytime up to April 2019) for studies evaluating the outcomes of TAVR in patients with or without AC. We assessed pooled estimates (with their 95% CIs) of the risk ratio (RR) for the all-cause mortality at the 30-day and 1-year follow-ups, a 4-point safety outcome (any bleeding, stroke, need for a pacemaker and acute kidney injury) and a 2-point efficacy outcome (device success and residual mean gradient (mean difference)). Three studies (5162 patients) were included. Of those patients, a total of 368 (7.1%) had AC. Apart from a significantly higher need for a postprocedural pacemaker (RR 1.29, 95% CI 1.06 to 1.58, p=0.01), TAVR in patients with AC resulted in similar outcomes for safety and efficacy at the 30-day follow-up compared with those without AC. Patients with AC experienced similar rates of the all-cause mortality at the 30-day follow-up compared with those without (RR 0.92, 95% CI 0.53 to 1.59, p=0.76); however, the all-cause mortality was significantly higher in patients with AC at the 1-year follow-up (RR 1.71, 95% CI 1.26 to 2.33, p=0.0006). This mortality difference was independent of cancer stage (advanced or limited) at the 30-day follow-up but not at the 1-year follow-up; only patients with limited cancer stages showed similar all-cause mortality rates compared with those without cancer at the 1-year follow-up (RR 1.22, 95% CI 0.79 to 1.91, p=0.37).
TAVR in patients with AC is associated with similar 30-day and potentially worse 1-year outcomes compared with those in patients without AC. The 1-year all-cause mortality appears to be dependent on the cancer stage. Involving a specialised oncologist who usually considers cancer stage in the decision-making process and applying additional preoperative scores such as frailty indices might refine the risk assessment process among these patients.
CRD42019120416.
患有严重主动脉瓣狭窄并伴有活动性癌症（AC）的患者被视为高危患者，通常不允许接受外科瓣膜置换术。经导管主动脉瓣置换术（TAVR）对他们来说可能是一个有吸引力的选择；然而，对于这一复杂患者亚组中TAVR的结果知之甚少。
在这项荟萃分析中，检索了Medline、Cochrane图书馆和Scopus数据库（截至2019年4月的任何时间），以查找评估有或无AC患者TAVR结果的研究。我们评估了30天和1年随访时全因死亡率的风险比（RR）的合并估计值（及其95%置信区间）、一个4分的安全性结果（任何出血、中风、需要起搏器和急性肾损伤）以及一个2分的有效性结果（器械成功和残余平均梯度（平均差值））。纳入了三项研究（5162例患者）。在这些患者中，共有368例（7.1%）患有AC。除了术后对起搏器的需求显著更高（RR 1.29，95%CI 1.06至1.58，p=0.01）外，AC患者的TAVR在30天随访时的安全性和有效性结果与无AC患者相似。AC患者在30天随访时的全因死亡率与无AC患者相似（RR 0.92，95%CI 0.53至1.59，p=0.76）；然而，AC患者在1年随访时的全因死亡率显著更高（RR 1.71，95%CI 1.26至2.33，p=0.0006）。这种死亡率差异在30天随访时与癌症分期（晚期或局限期）无关，但在1年随访时有关；只有癌症局限期的患者在1年随访时的全因死亡率与无癌症患者相似（RR 1.22，95%CI 0.79至1.91，p=0.37）。
与无AC患者相比，AC患者的TAVR在30天结果相似，但1年结果可能更差。1年全因死亡率似乎取决于癌症分期。让通常在决策过程中考虑癌症分期的专科肿瘤学家参与，并应用额外的术前评分，如衰弱指数，可能会完善这些患者的风险评估过程。
PROSPERO注册号：CRD42019120416。
