Frattini Silvia, Troise Giovanni, Fucci Carlo, Pressman Gregg S, Faggiano Pompilio
Cardiology Division, Cremona Hospital, Cremona, Italy.
Cardiac Surgery Division, Fondazione Poliambulanza, Brescia, Italy.
Expert Rev Cardiovasc Ther. 2021 Apr;19(4):289-299. doi: 10.1080/14779072.2021.1902306. Epub 2021 Mar 19.
. The prevalence of aortic valve stenosis (AS) and malignancy are both high, especially in elderly people and in developed countries. These two conditions frequently coexist and share the same risk factors as atherosclerotic disease.. The progression of calcified AS may be accelerated by both cardiovascular risk factors and cancer treatments, such as radiotherapy. The standard treatment for symptomatic severe AS is surgical aortic valve replacement; however, in cancer patients, transcatheter implantation may be preferred as they are often at high-risk for cardiac surgery. In patients with AS and cancer, physicians may face difficult treatment decisions.To date, there is limited information on the impact of malignancy on outcomes in patients with severe AS; hence, there is no established treatment policy.. Treating clinicians must integrate complex information about the severity of valve disease and expected cardiac outcomes with information regarding the cancer prognosis and the need for specific treatment, including surgery. Other comorbidities, age and frailty also contribute to decision-making about whether, when, and how to perform aortic valve replacement.
主动脉瓣狭窄（AS）和恶性肿瘤的患病率都很高，尤其是在老年人和发达国家。这两种情况经常同时存在，并且与动脉粥样硬化疾病具有相同的危险因素。钙化性AS的进展可能会因心血管危险因素和癌症治疗（如放疗）而加速。有症状的重度AS的标准治疗方法是外科主动脉瓣置换术；然而，在癌症患者中，经导管植入可能更受青睐，因为他们通常进行心脏手术的风险很高。在患有AS和癌症的患者中，医生可能面临艰难的治疗决策。迄今为止，关于恶性肿瘤对重度AS患者预后影响的信息有限；因此，尚无既定的治疗策略。治疗临床医生必须将关于瓣膜疾病严重程度和预期心脏结局的复杂信息与关于癌症预后以及包括手术在内的特定治疗需求的信息结合起来。其他合并症、年龄和虚弱程度也有助于决定是否、何时以及如何进行主动脉瓣置换。
