Transcatheter aortic valve implantation for patients with lung cancer and aortic valve stenosis

Clinical Outcomes and Prognostic Implications of TAVR in Patients With Active Cancer: A Meta-Analysis

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Transcatheter aortic valve replacement before to breast cancer management: case report and literature review

Background

The coexistence of aortic stenosis (AS) and neoplastic pathology are common due to shared risk factors with atherosclerotic disease, such as diabetes, inflammatory conditions, and smoking. Severe AS in patients with cancer requires careful assessment in order to select the appropriate therapeutic choices and their timing (i.e. valve treatment first vs. cancer treatment first).

Case summary

A 66-year-old woman with a history of smoking was admitted to our centre due to heart failure (HF). During her hospitalization, severe AS with severe ventricular dysfunction and cancer were documented. Because of her severe heart disease, she was unable to receive antineoplastic treatment. Therefore, she underwent percutaneous surgery to treat the aortic valve. After that, the management of cancer became possible, which included bilateral radical mastectomy and chemotherapy.We are presenting a case of cancer coexisting with aortic stenosis and reduced left ventricle ejection fraction. In this case, we performed Transcatheter Aortic Valve Replacement (TAVR) with the aim of improving the ejection fraction, followed by chemotherapy.

Discussion

Cancer patients may be further disadvantaged by AS if it interferes with their treatment by increasing the risk associated with oncologic surgery and compounding the risks associated with cardiotoxicity and HF. Clinical trials and guidelines on TAVR exclude cohorts with limited life expectancy. Hence, the correct and optimal care for cancer patients with severe AS is complex. The TAVR, for cancer patients with severe AS, can more frequently be the best clinical choice by avoiding cardiopulmonary bypass, minimal invasiveness, and therefore, shorter recovery time.

Aortic Valve Stenosis and Cancer: Problems of Management

Aortic valve stenosis and malignancy frequently coexist and share the same risk factors as atherosclerotic disease. Data reporting the prognosis of patients with severe aortic stenosis and cancer are limited. Tailoring the correct and optimal care for cancer patients with severe aortic stenosis is complex. Cancer patients may be further disadvantaged by aortic stenosis if it interferes with their treatment by increasing the risk associated with oncologic surgery and compounding the risks associated with cardiotoxicity and heart failure (HF). Surgical valve replacement, transcatheter valve implantation, balloon valvuloplasty, and medical therapy are possible treatments for aortic valve stenosis, but when malignancy is present, the choice between these options must take into account the stage of cancer and associated treatment, expected outcome, and comorbidities. Physical examination and Doppler echocardiography are critical in the diagnosis and evaluation of aortic stenosis. The current review considers the available data on the association between aortic stenosis and cancer and the therapeutic options.

Interventional Strategies in Cancer-induced Cardiovascular Disease

PURPOSE OF REVIEW

To highlight the range of illnesses and procedures that the interventional onco-cardiologists face in their daily practice, along with the recent additions to anti-cancer therapies and their related cardiotoxicity.

RECENT FINDINGS

Immune checkpoint inhibitors (ICI) are not devoid of cardiotoxicity as thought earlier and lead to an increased incidence of myocarditis. Transcatheter valve replacement has been shown to be a safer alternative to surgical replacement in cancer patients. Interventional onco-cardiology is a novel field that addresses cardiovascular diseases in the setting of cancer. Traditionally excluding cancer patients from clinical trials has led to a dearth of information needed to tackle cardiac conditions like Takotsubo cardiomyopathy, malignant pericardial effusions, and radiation-induced vascular diseases encountered either exclusively or predominantly in this high-risk population. This review discusses the various treatment options available in the interventional armamentarium with a particular focus on ICI-myocarditis and transcatheter aortic valve replacement in cancer patients.

Aortic valve stenosis and cancer: a common and complex association

Introduction. The prevalence of aortic valve stenosis (AS) and malignancy are both high, especially in elderly people and in developed countries. These two conditions frequently coexist and share the same risk factors as atherosclerotic disease.Area covered. The progression of calcified AS may be accelerated by both cardiovascular risk factors and cancer treatments, such as radiotherapy. The standard treatment for symptomatic severe AS is surgical aortic valve replacement; however, in cancer patients, transcatheter implantation may be preferred as they are often at high-risk for cardiac surgery. In patients with AS and cancer, physicians may face difficult treatment decisions.To date, there is limited information on the impact of malignancy on outcomes in patients with severe AS; hence, there is no established treatment policy.Expert Opinion. Treating clinicians must integrate complex information about the severity of valve disease and expected cardiac outcomes with information regarding the cancer prognosis and the need for specific treatment, including surgery. Other comorbidities, age and frailty also contribute to decision-making about whether, when, and how to perform aortic valve replacement.

A case of oral cancer with preoperative transcatheter aortic valve implantation for aortic stenosis: A case report

Aortic valve stenosis [or aortic stenosis, (AS)] is a risk factor in non-cardiac surgery. Guidelines from the European Heart Association recommended that AS treatment should be applied prior to non-cardiac surgery. Transcatheter aortic valve implantation (TAVI) is a method of minimally invasive AS treatment. The present study reports a case of tongue excision and neck dissection after TAVI for a patient with tongue cancer and AS. A 79-year-old woman was diagnosed with AS following preoperative examination for tongue cancer. The patient was judged as a high-risk case for open-heart surgery after consultation with staff at the University Hospital of The Ryukyus. It was concluded that TAVI should be performed prior to cancer surgery. On day 21 following TAVI, cancer surgery was performed and the patient was discharged from hospital 22 days after tongue cancer surgery. To the best of our knowledge, there is no report of oral cancer surgery after TAVI. TAVI is generally used as a short-term treatment strategy for AS associated with head and neck cancer due to its minimally invasive nature. In the present case, oral cancer surgery was performed closely following TAVI without serious complications. The case demonstrated that TAVI might be useful for severe AS patients with high surgical risk prior to cancer resection surgery. However, further cases are required to confirm the safety and effectiveness of TAVI treatment strategies.

Cardiac Interventional Procedures in Cardio-Oncology Patients

Comorbidities specific to the cardio-oncology population contribute to the challenges in the interventional management of patients with cancer and cardiovascular disease (CVD). Patients with cancer have generally been excluded from cardiovascular randomized clinical trials. Endovascular procedures may represent a valid option in patients with cancer with a range of CVDs because of their minimally invasive nature. Patients with cancer are less likely to be treated according to societal guidelines because of perceived high risk. This article presents the specific challenges that interventional cardiologists face when caring for patients with cancer and the modern tools to optimize care.

Laparoscopic colectomy after transcatheter aortic valve implantation in an elderly patient with obstructive descending colon cancer and severe aortic stenosis: a case report

BACKGROUND

The demand for laparoscopic colectomy is increasing due to greater number of elderly colon cancer patients, and it is important to evaluate existing comorbidities to ensure perioperative safety. Aortic stenosis (AS) is one of the most common heart diseases in the elderly, and elderly cancer patients with severe AS may be considered ineligible for optimal cancer treatment if they cannot endure surgical aortic valve replacement (SAVR). Recently, transcatheter aortic valve implantation (TAVI) has become a valid option in patients who are high risk for SAVR. We herein present the first case of an elderly cancer patient with severe AS who underwent laparoscopic colectomy after TAVI.

CASE PRESENTATION

An 87-year-old woman with a history of multiple cardiovascular diseases was diagnosed with obstructive descending colon cancer and initially underwent colonic stenting. However, as preoperative echocardiography revealed severe AS, she underwent TAVI prior to the colectomy to reduce perioperative risk. TAVI was chosen instead of SAVR due to high SAVR mortality risk, and laparoscopic colectomy was performed 22 days after TAVI. Her postoperative course was uneventful, and she was discharged 14 days later without any deterioration in general condition. No recurrence was observed at more than 1 year, even without adjuvant therapy.

CONCLUSION

TAVI facilitated subsequent laparoscopic colectomy in an elderly cancer patient with severe AS. Our case report shows that TAVI may enable further cancer treatment even in patients with severe AS, who may otherwise be considered not suitable for such treatments.

Two cases of lobectomy for lung cancer after transcatheter aortic valve implantation

BACKGROUND

The age of patients with lung cancer is advancing, and the number of patients with lung cancer who have cardiac diseases is expected to increase. Recently, the rate of transcatheter aortic valve implantation (TAVI) has increased as treatment for aortic stenosis (AS). TAVI is minimally invasive compared with conventional aortic valve replacement. We herein report two patients with lung cancer who underwent lobectomy after TAVI for severe AS.

CASE PRESENTATION

Two patients with AS and lung cancer were treated with two-stage surgery of TAVI followed by lobectomy. In patient 1 (77 years of age), conventional aortic valve replacement was considered to be risky because of his history of coronary artery disease and thoracic aortic aneurysm and his relatively high logistic euroSCORE. He underwent TAVI followed by right middle and lower lobectomy. In patient 2 (75 years of age), TAVI was chosen because the patient had poor ADL due to spinal canal stenosis and had taken immunosuppressant agents after a kidney transplantation. He underwent TAVI followed by right lower lobectomy. The postoperative course of the two patients was uneventful.

CONCLUSIONS

Two-stage surgery of TAVI and lung resection could be a viable option for patients with both lung cancer and severe AS, for whom conventional AVR by an open-heart operation is not indicated.