Lind Alexander, Totzeck Matthias, Mahabadi Amir A, Jánosi Rolf A, El Gabry Mohamed, Ruhparwar Arjang, Mrotzek Simone M, Hinrichs Lena, Akdeniz Merve, Rassaf Tienush, Mincu Raluca I
Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
Department of Cardiovascular und Thoracic Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
JACC CardioOncol. 2020 Dec 15;2(5):735-743. doi: 10.1016/j.jaccao.2020.11.008. eCollection 2020 Dec.
The use of transcatheter aortic valve replacement (TAVR) in cancer survivors and patients with active cancer (AC) in cancer survivors and patients with active cancer (AC) is expanding, suggesting a need to adjust the indications and risk assessment pre-TAVR.
The purpose of this study was to determine the impact of cancer on peri-procedural complications and survival in a long-term, single-center cohort of patients treated with TAVR.
Patients treated with TAVR between January 2006 and December 2018 were grouped as follows: controls (patients without cancer), stable cancer (SC), and AC. The primary endpoints were peri-procedural complications and 30-day survival. A secondary endpoint was 10-year survival.
A total of 1,088 patients (age 81 ± 5 years, 46.6% men) treated with transfemoral TAVR were selected: 839 controls, 196 SC, and 53 AC. Predominant malignancies were breast, gastrointestinal, and prostate cancer. No differences were observed between patients with cancer and controls regarding peri-procedural complications. Patients with AC had similar 30-day survival compared with controls and SC (94.3% vs. 93.3% vs. 96.9%, p = 0.161), but as expected, reduced 10-year survival. AC was associated with a 1.47 (95% CI 1.16 to 1.87) fold increased risk of all-cause 10-year mortality in multivariable adjusted models.
TAVR should be performed in patients with cancer when indicated, considering that patients with cancer have similar periprocedural complications and short-term survival compared with control patients. However, patients with AC have worse 10-year survival. Future studies are needed to define cancer-specific determinants of worse long-term survival.
经导管主动脉瓣置换术（TAVR）在癌症幸存者以及患有活动性癌症（AC）的患者中的应用正在扩大，这表明需要在TAVR术前调整适应证和风险评估。
本研究的目的是确定在一个长期的、单中心接受TAVR治疗的患者队列中，癌症对围手术期并发症和生存的影响。
将2006年1月至2018年12月期间接受TAVR治疗的患者分为以下几组：对照组（无癌症患者）、稳定期癌症（SC）组和AC组。主要终点是围手术期并发症和30天生存率。次要终点是10年生存率。
共选择了1088例经股动脉TAVR治疗的患者（年龄81±5岁，46.6%为男性）：839例对照组、196例SC组和53例AC组。主要恶性肿瘤为乳腺癌、胃肠道癌和前列腺癌。在围手术期并发症方面，癌症患者与对照组之间未观察到差异。AC组患者的30天生存率与对照组和SC组相似（94.3%对93.3%对96.9%，p = 0.161），但正如预期的那样，10年生存率降低。在多变量调整模型中，AC与全因10年死亡率风险增加1.47倍（95%CI 1.16至1.87）相关。
有适应证的癌症患者应进行TAVR，因为与对照患者相比，癌症患者的围手术期并发症和短期生存率相似。然而，AC患者的10年生存率较差。未来需要开展研究来确定导致长期生存较差的癌症特异性决定因素。
