Murphy Alexandra C, Koshy Anoop N, Cameron William, Horrigan Mark, Kearney Leighton, Yeo Belinda, Farouque Omar, Yudi Matias B
Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.
Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
Catheter Cardiovasc Interv. 2021 Jan 1;97(1):157-164. doi: 10.1002/ccd.28969. Epub 2020 Jun 4.
A history of cancer is incorporated into the surgical risk assessment of patients undergoing surgical aortic valve replacement through the Society for Thoracic Surgeons score. However, the prognostic significance of cancer in patients treated with transcatheter aortic valve replacement (TAVR) is unclear. As the cancer survivorship population increases, it is imperative to establish the efficacy and safety of TAVR in patients with severe symptomatic aortic stenosis (AS) and a history of malignancy.
The primary goal of this study was to assess the periprocedural outcomes and long-term mortality in patients with a history of cancer undergoing TAVR.
A systematic review of PubMed, MEDLINE, and EMBASE was conducted to identify studies reporting outcomes in patients with a history of malignancy undergoing TAVR. A meta-analysis was performed using a random-effects model with a primary outcome of all-cause mortality and cardiac mortality at the longest follow-up. On secondary analyses, procedural safety was assessed.
A total of 13 observational studies with 10,916 patients were identified in the systematic review. Seven studies including 6,323 patients were included in the quantitative analysis. Short-term mortality (relative risk [RR] 0.61, 95%CI 0.36-1.01; p = .06) and long-term all-cause mortality (RR 1.24, 95%CI 0.95-1.63; p = .11) were not significantly different when comparing patients with and without a history of cancer. No significant difference in the rate of periprocedural complications including stroke, bleeding, acute kidney injury, and pacemaker implantation was noted.
In patients with severe AS undergoing TAVR, a history of cancer was not associated with adverse short or long-term survival. Based on these findings, TAVR should be considered in all patients with severe symptomatic AS, irrespective of their history of malignancy.
通过胸外科医师协会评分，癌症病史被纳入接受外科主动脉瓣置换术患者的手术风险评估中。然而，经导管主动脉瓣置换术（TAVR）治疗患者中癌症的预后意义尚不清楚。随着癌症幸存者群体的增加，确定TAVR在有严重症状性主动脉瓣狭窄（AS）和恶性肿瘤病史患者中的疗效和安全性至关重要。
本研究的主要目标是评估接受TAVR的有癌症病史患者的围手术期结局和长期死亡率。
对PubMed、MEDLINE和EMBASE进行系统综述，以确定报告有恶性肿瘤病史患者接受TAVR结局的研究。使用随机效应模型进行荟萃分析，主要结局为最长随访时的全因死亡率和心脏死亡率。在二次分析中，评估手术安全性。
在系统综述中总共确定了13项观察性研究，涉及10916例患者。定量分析纳入了7项研究，共6323例患者。比较有和没有癌症病史的患者时，短期死亡率（相对风险[RR]0.61，95%CI 0.36 - 1.01；p = 0.06）和长期全因死亡率（RR 1.24，95%CI 0.95 - 1.63；p = 0.11）无显著差异。围手术期并发症发生率，包括中风、出血、急性肾损伤和起搏器植入，均无显著差异。
在接受TAVR的严重AS患者中，癌症病史与短期或长期生存不良无关。基于这些发现，所有有严重症状性AS的患者，无论其恶性肿瘤病史如何，都应考虑TAVR。
