Ahsan Umar, Naz Samia, Anum Aroba, Unum Amara, Hamza Rana M, Qasim Rana M, Taaruf Ansub, Khan Nishat
Emergency Medicine, Epsom and St. Helier University Hospitals NHS Trust, London, GBR.
Emergency Medicine, Sir Ganga Ram Hospital, Lahore, PAK.
Cureus. 2024 Nov 11;16(11):e73442. doi: 10.7759/cureus.73442. eCollection 2024 Nov.
Aortic valve disease and cancer are significant causes of mortality, especially in older populations. This meta-analysis addresses a critical question in the management of patients with both aortic valve disease and cancer. As these two conditions are major contributors to mortality, determining the best course of treatment can be complex. Traditionally, randomized controlled trials (RCTs) exclude cancer patients, leaving a gap in clinical evidence. This study steps in to fill that gap by pooling data from over 120,000 patients in 15 cohort studies, following PRISMA guidelines to evaluate the safety and effectiveness of transcatheter aortic valve replacement (TAVR) in cancer patients. The primary focus of the analysis was all-cause mortality, with secondary outcomes including stroke, pacemaker implantation, acute kidney injury, major bleeding, and vascular complications. The results revealed no statistically significant differences between cancer and non-cancer groups in terms of mortality or complications. These findings suggest that TAVR can be a safe and effective option for patients with cancer, suggesting that deferring cardiovascular interventions in favor of cancer treatment may not always be necessary. However, the observational nature of the included studies does introduce potential biases, such as confounding factors and selection bias. The study highlights the need for more targeted research that focuses on specific types and stages of cancer to better understand how these factors may influence outcomes. Despite these limitations, the meta-analysis provides valuable insights and suggests that TAVR could be a viable treatment path for patients managing both cancer and aortic valve disease.
主动脉瓣疾病和癌症是导致死亡的重要原因，尤其是在老年人群中。这项荟萃分析解决了同时患有主动脉瓣疾病和癌症患者管理中的一个关键问题。由于这两种疾病是导致死亡的主要因素，确定最佳治疗方案可能很复杂。传统上，随机对照试验（RCT）将癌症患者排除在外，导致临床证据存在空白。本研究通过汇总15项队列研究中超过12万名患者的数据，按照PRISMA指南评估经导管主动脉瓣置换术（TAVR）在癌症患者中的安全性和有效性，从而填补这一空白。分析的主要重点是全因死亡率，次要结果包括中风、起搏器植入、急性肾损伤、大出血和血管并发症。结果显示，癌症组和非癌症组在死亡率或并发症方面没有统计学上的显著差异。这些发现表明，TAVR对癌症患者可能是一种安全有效的选择，这表明推迟心血管干预以优先进行癌症治疗可能并非总是必要的。然而，纳入研究的观察性本质确实引入了潜在偏差，如混杂因素和选择偏差。该研究强调需要进行更有针对性的研究，聚焦于癌症的特定类型和阶段，以更好地了解这些因素如何影响治疗结果。尽管存在这些局限性，该荟萃分析提供了有价值的见解，并表明TAVR可能是同时患有癌症和主动脉瓣疾病患者的一种可行治疗途径。
