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. 2016 May 12;11(5):e0155398.
doi: 10.1371/journal.pone.0155398. eCollection 2016.

Thoracic Malignancies and Pulmonary Nodules in Patients under Evaluation for Transcatheter Aortic Valve Implantation (TAVI): Incidence, Follow Up and Possible Impact on Treatment Decision

Lars Henning Schmidt  1 , Benedikt Vietmeier  1 , Gerrit Kaleschke  2 , Christoph Schülke  3 , Dennis Görlich  4 , Christoph Schliemann  1 , Torsten Kessler  1 , Arik Bernard Schulze  1 , Boris Buerke  3 , Andreas Kuemmel  5 , Michael Thrull  1 , Rainer Wiewrodt  1 , Helmut Baumgartner  2 , Wolfgang E Berdel  1 , Michael Mohr  1
Affiliations

Thoracic Malignancies and Pulmonary Nodules in Patients under Evaluation for Transcatheter Aortic Valve Implantation (TAVI): Incidence, Follow Up and Possible Impact on Treatment Decision

Lars Henning Schmidt et al. PLoS One. .

Abstract

Background: Transcatheter aortic valve implantation (TAVI) has become the treatment of choice in patients with severe aortic valve stenosis who are not eligible for operative replacement and an alternative for those with high surgical risk. Due to high age and smoking history in a high proportion of TAVI patients, suspicious findings are frequently observed in pre-procedural chest computer tomography (CCT).

Methods: CCT scans of 484 consecutive patients undergoing TAVI were evaluated for incidentally discovered solitary pulmonary nodules (SPN).

Results: In the entire study population, SPN ≥ 5 mm were found in 87 patients (18%). These patients were compared to 150 patients who were incidentally collected from the 397 patients without SPN or with SPN < 5 mm (control group). After a median follow-up of 455 days, lung cancer was diagnosed in only two patients. Neither SPN ≥ 5 mm (p = 0.579) nor SPN > 8 mm (p = 0.328) were significant predictors of overall survival.

Conclusions: Despite the high prevalence of SPNs in this single center TAVI cohort lung cancer incidence at midterm follow-up seems to be low. Thus, aggressive diagnostic approaches for incidentally discovered SPN during TAVI evaluation should not delay the treatment of aortic stenosis. Unless advanced thoracic malignancy is obvious, the well documented reduction of morbidity and mortality by TAVI outweighs potentially harmful delays regarding further diagnostics. Standard guideline-approved procedure for SPN can be safely performed after TAVI.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Diagnostic strategies for incidentally discovered solitary pulmonary nodules (adapted from: Gould et al. 2013).
Fig 2
Fig 2. Study collective and tested clinical subgroups.
The flow diagram demonstrates the selection of the tested subgroups (*control group includes both patients without detected SPN and those patients with SPN<5mm).
Fig 3
Fig 3. Prognostic impact of solitary pulmonary nodules (SPN), lymphadenopathy (LAP) and pleural effusions (PE) in patients under evaluation for TAVI (n = 237 patients).
Kaplan Meier charts are given for SPN ≥ 5mm (A), for SPN > 8mm (B), for LAP (C) and for PE (D).
Fig 4
Fig 4. Prognostic impact of left ventricular ejection fraction (LVEF) in the full study collective (p = 0.004).
Overall survival of those patients with a LVEF ≥ 45% was increased compared to those patients with a LVEF < 45%.
See this image and copyright information in PMC

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References

    1. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9–29. 10.3322/caac.21208 - DOI - PubMed
    1. Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, et al. Reduced lung cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011;365:395–409. 10.1056/NEJMoa1102873 - DOI - PMC - PubMed
    1. Stang A, Schuler M, Kowall B, Darwiche K, Kühl H, Jöckel KH. Lung Cancer Screening Using Low Dose CT Scanning in Germany. Dtsch Arztebl Int. 2015;112(38):637–644. 10.3238/arztebl.2015.0637 - DOI - PMC - PubMed
    1. Aberle DR, DeMello S, Berg CD, Black WC, Brewer B, Church TR, et al.; National Lung Screening Trial Research Team. Results of the two incidence screenings in the National Lung Screening Trial. N Engl J Med. 2013;369(10):920–931. 10.1056/NEJMoa1208962 - DOI - PMC - PubMed
    1. Ost D, Fein AM, Feinsilver SH. Clinical practice. The solitary pulmonary nodule. N Engl J Med. 2003;348(25):2535–2542. - PubMed

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