Author + information
- Marco Russo1,
- Shingo Kuwata2,
- Alberto Pozzoli3,
- Fabian Nietlispach4,
- Alberto Weber1,
- Stefano Benussi5,
- Maurizio Taramasso6 and
- Francesco Maisano7
- 1University Heart Center, Universitätsspital Zürich, Zürich, Switzerland
- 2University Hospital Zürich, Zürich, Switzerland
- 3Zürich University Hospital, Zürich, Switzerland
- 4University Hospital Zurich, Zurich, Switzerland
- 5University Heart Center, Universitätsspital Zürich, Zurich, Switzerland
- 6University Hospital of Zurich, Zurich, Switzerland
- 7UniversitätsSpital Zürich, Zürich, Switzerland
Prognostic impact of transcatheter valve implantation has been largely proved in the last decade. Thus, the fate of patients treated by TAVI with concomitant advanced active malignancy has been not still clarified. We retrospectively evaluated our single center experience.
Out of 698 patients referred for TAVI procedures from January 2013 to December 2016, 12 consecutive patients (1.7%) (mean age 75 ± 9 years; 6 men) had an active advanced malignancy (Stage III, 4 cases; Stage IV, 8 cases) either known before or detected during pre-TAVI assessment. Organ cancers were present in 7 patients (58%) and hematological malignancies in 5 (42%). Active pre-cancer treatment was performed in 8 patients. Indication for TAVI was established by heart-team evaluation. Pre-procedural EuroSCORE II and STS mortality were 3.18 ± 1.76% and 2.8 ± 1.9%, respectively. Preoperative echo showed pure aortic stenosis in 8 patients, pure aortic regurgitation in 1 case and mixed disease in 2 cases. Baseline LVEF was 52 ± 12%. Follow-up (mean 13 ± 7 months, range 4-24) was 98% complete.
In-hospital survival was 100%. All the procedures were performed with trans-femoral approach (3 Sapien 3, 5 Evolut R, 2 Medtronic Corevalve, 1 Direct Flow, 2 St. Jude Portico). There were no infarctions, no strokes, 2 major vascular complication, 1 major bleeding, 2 cases of need for new pacemaker implantation. The mean gradient decreased from 42 .2± 20.1 to 10.1 ± 4.1 mmHg. At 1 year follow up freedom from all-cause mortality was 89 ± 11 % with no case of cancer related death recorded and no case of cardiotoxic effect of medical therapy. A cancer regression was achieved in 3 cases (25%).
Transcatheter aortic valve implantation in advanced stage cancer patients is a safe procedure and it is not associated with increased in-hospital mortality. TAVI provides satisfactory freedom from cardiac and cancer related death at 1 year follow up.
STRUCTURAL: Valvular Disease: Aortic