Saberian Parsa, Contreras Rafael, Gurram Anoop, Nasrollahizadeh Amir, Keetha Narsimha Rao, Nguyen Anthony Loc, Nayak Sandeep Samethadka, Keivanlou Mohammad-Hossein, Hashemi Mohammad, Amini-Salehi Ehsan, Ameen Daniyal
Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
Department of Internal Medicine, Yale New Heaven Health Bridgeport Hospital 267 Grant St, Bridgeport, CT, USA.
Clin Cardiol. 2025 Mar;48(3):e70121. doi: 10.1002/clc.70121.
Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for high-risk patients with severe aortic stenosis (AS). However, the clinical outcomes and prognostic implications of TAVR in patients with active cancer remain uncertain. This meta-analysis evaluates procedural success, complications, and survival outcomes of TAVR in patients with and without active cancer.
A comprehensive literature search was conducted across PubMed, Scopus, and Web of Science databases. Statistical analysis was performed using a random-effects model. Statistical analyses were conducted using STATA version 18.0.
The results of the meta-analysis showed no significant difference in in-hospital mortality between cancer and non-cancer patients (OR = 1.17; 95% CI: 0.83, 1.65; p = 0.27). Similarly, 30-day mortality did not differ between the two groups (OR = 0.93; 95% CI: 0.72, 1.19; p = 0.49). However, 1-year mortality was significantly higher in cancer patients (OR = 1.93; 95% CI: 1.45, 2.56; p < 0.01). Two-year mortality was also higher in cancer patients (OR = 2.65; 95% CI: 1.79, 3.93; p < 0.01). No significant differences were observed in major bleeding, acute kidney injury, stroke, or permanent pacemaker implantation between the groups.
While TAVR offers comparable in-hospital and short-term survival outcomes for cancer and non-cancer patients, long-term mortality is significantly higher in those with active cancer. These findings suggest that TAVR is a viable option for cancer patients with severe AS but requires careful long-term prognostic considerations. Further studies are needed to optimize management strategies for this complex population.
对于患有严重主动脉瓣狭窄（AS）的高危患者，经导管主动脉瓣置换术（TAVR）是外科主动脉瓣置换术（SAVR）的一种替代方案。然而，TAVR在患有活动性癌症的患者中的临床结局和预后影响仍不确定。本荟萃分析评估了TAVR在有或无活动性癌症患者中的手术成功率、并发症和生存结局。
对PubMed、Scopus和Web of Science数据库进行了全面的文献检索。使用随机效应模型进行统计分析。使用STATA 18.0版本进行统计分析。
荟萃分析结果显示，癌症患者和非癌症患者的住院死亡率无显著差异（OR = 1.17；95% CI：0.83，1.65；p = 0.27）。同样，两组之间的30天死亡率也无差异（OR = 0.93；95% CI：0.72，1.19；p = 0.49）。然而，癌症患者的1年死亡率显著更高（OR = 1.93；95% CI：1.45，2.56；p < 0.01）。癌症患者的2年死亡率也更高（OR = 2.65；95% CI：1.79，3.93；p < 0.01）。两组之间在大出血、急性肾损伤、中风或永久性起搏器植入方面未观察到显著差异。
虽然TAVR为癌症患者和非癌症患者提供了相当的住院和短期生存结局，但活动性癌症患者的长期死亡率显著更高。这些发现表明，TAVR对于患有严重AS的癌症患者是一种可行的选择，但需要仔细考虑长期预后。需要进一步研究以优化这一复杂人群的管理策略。
