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Observational Study
. 2015 Jul;16(7):731-7.
doi: 10.1093/ehjci/jev055. Epub 2015 Mar 10.

Two-year survival of patients screened for transcatheter aortic valve replacement with potentially malignant incidental findings in initial body computed tomography

Peter Stachon  1 , Klaus Kaier  2 , Simone Milde  1 , Gregor Pache  3 , Stefan Sorg  1 , Matthias Siepe  1 , Constantin von zur Mühlen  1 , Andreas Zirlik  1 , Friedhelm Beyersdorf  1 , Mathias Langer  3 , Manfred Zehender  1 , Christoph Bode  1 , Jochen Reinöhl  4
Affiliations
Observational Study

Two-year survival of patients screened for transcatheter aortic valve replacement with potentially malignant incidental findings in initial body computed tomography

Peter Stachon et al. Eur Heart J Cardiovasc Imaging. 2015 Jul.

Abstract

Aims: Recently, transcatheter aortic valve replacement (TAVR) has evolved as the standard treatment in patients with inoperable aortic valve stenosis. According to TAVR guidelines, body computed tomography (CT) is recommended for pre-procedural planning. Due to the advanced age of these patients, multiple radiological potentially malignant incidental findings (pmIFs) appear in this cohort. It is unknown how pmIFs influence the decision by the heart team to intervene and the mortality.

Methods and results: We evaluated in a retrospective single-centre observational study 414 participants screened for TAVR with dual-source CT between October 2010 and December 2012. pmIFs are common and appeared in 18.7% of all patients screened for TAVR. The decision to intervene by TAVR or surgical aortic valve replacement (SAVR) was made by an interdisciplinary heart team and the role of pmIF in decision-making and time to treatment with TAVR or SAVR was analysed, retrospectively. The appearance of a pmIF vs. no pmIF did not significantly influence therapeutic decisions [odds ratio (OR) 1.14; P = 0.835] or time to treatment (91 ± 152 vs. 61 ± 109 days, respectively). Several findings, which are highly suspicious for malignancy, were less likely associated with invasive treatment (OR 0.207; P = 0.046). Patient survival was evaluated for at least 2 years until January 2014. Two-year survival of patients after TAVR or SAVR, treated according to the heart team decision, was ∼75% and independent from the presence of a non-severe (P = 0.923) or severe (P = 0.823) pmIF.

Conclusion: The study indicates that frequently occurring radiologic pmIF did not influence 2-year survival after a decision to intervene was made by an interdisciplinary heart team.

Keywords: TAVI; TAVR; aortic valve replacement; aortic valve stenosis; cancer; computed tomography; incidental finding; malignancy; mortality.

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Figures

Figure 1
Figure 1
The flow diagram shows eligible participants. pmIFs were classified into ‘severe’ and ‘non-severe’. The interdisciplinary heart team made the decision for TAVR, SAVR, or drug therapy only.
Figure 2
Figure 2
Time to treatment was retrospectively analysed in patients with or without pmIF. Results are presented in days after decision-making to the intervention. Decision of the interdisciplinary heart team is stated below.
Figure 3
Figure 3
Kaplan–Meier survival curves for patients without pmIF, with severe or non-severe pmIF receiving invasive treatment (TAVR or SAVR). P-values for comparison of the survival distributions between groups were calculated with the log-rank test.
See this image and copyright information in PMC

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References

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