Mohanty Bibhu D, Coylewright Megan, Sequeira Ashton R, Shin Doosup, Liu Yangbo, Li Ditian, Fradley Michael, Alu Maria C, Mack Michael J, Kapadia Samir R, Kodali Susheel, Thourani Vinod H, Makkar Raj R, Leon Martin B, Malenka David
Department of Cardiovascular Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Department of Cardiology, Erlanger Health System, Chattanooga, Tennessee, USA.
Catheter Cardiovasc Interv. 2022 May;99(6):1877-1885. doi: 10.1002/ccd.30154. Epub 2022 Mar 15.
The purpose of this study is to investigate the viability of transcatheter aortic valve replacement (TAVR) for severe symptomatic aortic stenosis (AS) in patients with prior chest radiation therapy (cXRT).
Since patients with prior cXRT perform poorly with surgical aortic valve replacement, TAVR can be a viable alternative. However, clinical outcomes after TAVR in this patient population have not been well studied.
From the pooled registry of the placement of aortic transcatheter valves II trial, we identified patients with and without prior cXRT who underwent TAVR (n = 64 and 3923, respectively). The primary outcome was a composite of all-cause death and any stroke at 2 years. Time to event analyses were shown as Kaplan-Meier event rates and compared by log-rank testing. Hazard ratios (HRs) were estimated and compared by Cox proportional hazards regression model.
There was no significant difference in the primary outcome between the patients with and without prior cXRT (30.7% vs. 27.0%; p = 0.75; HR, 1.08; 95% confidence interval, 0.66-1.77). Rates of myocardial infarction, vascular complications, acute kidney injury, or new pacemaker implant after TAVR were not statistically different between the two groups. The rate of immediate reintervention with a second valve for aortic regurgitation after TAVR was higher among the patients with prior cXRT. However, no further difference was observed during 2 years follow-up after discharge from the index-procedure hospitalization.
TAVR is a viable alternative for severe symptomatic AS in patients who had cXRT in the past.
