Transcatheter Aortic Valve Replacement is a Viable Option to Improve Mortality in Cancer Patients with Severe Aortic Stenosis Considered High Risk for Surgical Aortic Valve Replacement

Background
Degenerative calcific aortic stenosis (AS) is the most prevalent heart valve disease in developed countries. Cancer patients are often considered high surgical risk given their hematologic abnormalities, multi-organ dysfunction, and frailty. We sought to determine if transcatheter aortic valve replacement (TAVR) is an acceptable alternative to surgical aortic valve replacement (SAVR) in cancer patients.

Methods
Cancer patients in a tertiary cancer center diagnosed with severe AS by American Society for Echocardiography guidelines were retrospectively included. Patients accepted by the heart team underwent either TAVR or SAVR while the remaining patients received no aortic valve replacement (NAVR) and were treated with medical therapy alone. Logistic regression was performed to determine the impact on overall survival (OS) in all 3 subgroups.

Results
One hundred and eighty-seven cancer patients diagnosed with severe AS were identified. Aortic valve replacement was associated with a better OS compared to medical therapy alone (p<0.0001). TAVR was associated with a better OS at 72 months (HR=0.468, p<0.001) compared to medical therapy alone with no difference in OS observed between SAVR and TAVR.

Conclusions
Cancer patients with severe AS benefit from aortic valve replacement. TAVR should be considered as a viable alternative to SAVR in high-risk cancer patients to prolong survival and possibly allow for earlier administration or resumption of anti-neoplastic therapies.