Karaduman Bilge Duran, Ayhan Hüseyin, Keleş Telat, Bozkurt Engin
Department of Cardiology, Atılım University, Faculty of Medicine, Medicana International Ankara Hospital, Ankara, Turkey.
Department of Cardiology, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara City Hospital, Ankara, Turkey.
Turk Gogus Kalp Damar Cerrahisi Derg. 2021 Jan 13;29(1):45-51. doi: 10.5606/tgkdc.dergisi.2021.20622. eCollection 2021 Jan.
In this study, we aimed to evaluate the clinical characteristics, perioperative, and mid-term outcomes of patients with severe symptomatic aortic stenosis and active cancer disease and cancer survivors undergoing transcatheter aortic valve implantation.
Between December 2011 and March 2019, a total of 550 patients (248 males, 302 females; mean age: 77.6±7.9 years; range, 46 to 103 years) who underwent transcatheter aortic valve implantation for severe symptomatic aortic stenosis in our center were retrospectively analyzed. Baseline demographic characteristics, cancer type, laboratory data, procedural data, and outcome data of the patients were collected. The primary outcome measure was all-cause mortality at 30 days and every six months up to maximally available follow-up. Follow-up was performed at 30 days, six months, and 12 months after the procedure and annually thereafter.
Of the patients, 36 had a cancer diagnosis-active (n=10) or cured (n=26). The most common types of cancer were colorectal (16.6%), prostate (13.8%), leukemia (11.1%), and bladder (11.1%) cancers. Post-procedural complication rates were similar between the two groups. No mortality was observed in the cancer group at one month of follow-up. During follow-up, seven patients died within one year due to non-cardiac reasons. Although mortality at one year was higher in cancer patients, it did not reach statistical significance (23.3% vs. 11.6%, respectively; p=0.061). The estimated cumulative survival rate was 71.0% in the non-cancer group and 58.3% in the cancer group. The multivariate Cox regression analysis revealed that cancer was independently associated with cumulative mortality after adjusting for age, sex, body mass index, and atrial fibrillation (p=0.008).
Our study results show that transcatheter aortic valve implantation is safe and feasible in active cancer patients and cancer survivors with similar short-term and mid-term mortality and procedure-related complication rates, compared to non-cancer patients.
在本研究中，我们旨在评估有严重症状性主动脉瓣狭窄且患有活动性癌症疾病以及癌症幸存者的患者接受经导管主动脉瓣植入术的临床特征、围手术期及中期结局。
回顾性分析2011年12月至2019年3月期间在我们中心因严重症状性主动脉瓣狭窄接受经导管主动脉瓣植入术的550例患者（248例男性，302例女性；平均年龄：77.6±7.9岁；范围46至103岁）。收集患者的基线人口统计学特征、癌症类型、实验室数据、手术数据及结局数据。主要结局指标为30天及每六个月直至最长可获得随访期的全因死亡率。术后30天、六个月及12个月进行随访，此后每年随访一次。
患者中，36例有癌症诊断——活动性癌症（n = 10）或已治愈（n = 26）。最常见的癌症类型为结直肠癌（16.6%）、前列腺癌（13.8%）、白血病（11.1%）和膀胱癌（11.1%）。两组术后并发症发生率相似。癌症组随访1个月时未观察到死亡病例。随访期间，7例患者在1年内因非心脏原因死亡。虽然癌症患者1年时的死亡率较高，但未达到统计学显著性（分别为23.3%和11.6%；p = 0.061）。非癌症组的估计累积生存率为71.0%，癌症组为58.3%。多因素Cox回归分析显示，在调整年龄、性别、体重指数和心房颤动后，癌症与累积死亡率独立相关（p = 0.008）。
我们的研究结果表明，与非癌症患者相比，经导管主动脉瓣植入术在患有活动性癌症的患者和癌症幸存者中是安全可行的，短期和中期死亡率及手术相关并发症发生率相似。
