Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May 2:40:101045.
doi: 10.1016/j.ijcha.2022.101045. eCollection 2022 Jun.

Prognosis of patients with active cancer undergoing transcatheter aortic valve implantation: An insight from Japanese multicenter registry

Yoshimasa Kojima  1   2 , Ryosuke Higuchi  1 , Kenichi Hagiya  1 , Mike Saji  1 , Itaru Takamisawa  1 , Nobuo Iguchi  1 , Shuichiro Takanashi  3 , Shinichiro Doi  4 , Shinya Okazaki  4 , Kei Sato  5 , Harutoshi Tamura  6 , Morimasa Takayama  1 , Takanori Ikeda  2 , Mitsuaki Isobe  1
Affiliations

Prognosis of patients with active cancer undergoing transcatheter aortic valve implantation: An insight from Japanese multicenter registry

Yoshimasa Kojima et al. Int J Cardiol Heart Vasc. .

Abstract

Background: Malignancy is common in older adults undergoing transcatheter aortic valve implantation (TAVI), and may affect prognosis. The present study aimed to examine whether active cancer affects all-cause mortality rates among patients undergoing TAVI.

Methods: This retrospective study examined data from 1,114 consecutive patients treated between April 2010 and June 2019. Patients with life expectancy of <1 year due to non-cardiac causes were excluded.

Results: Active cancer was defined as cancer under treatment or cured within 1 year, and was recognized in 62 patients (5.6%) with (n = 17) and without (n = 45) metastases. In multivariate analysis, being female (hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.39-0.77, p < 0.001), body mass index (BMI) (HR = 0.92 per 1 kg/m2 increase, 95% CI 0.87-0.97, p = 0.001), New York Heart Association (NYHA) class III/IV (HR = 1.53, 95% CI 1.06-2.20, p = 0.022), atrial fibrillation (HR = 2.40, 95% CI 1.70-3.38, p < 0.001), albumin levels (HR = 0.41 per 1-g/dl, 95% CI 0.30-0.57, p < 0.001), and cancer metastasis (HR = 5.28, 95% CI 1.86-14.9, p = 0.001) were associated with all-cause mortality after TAVI.

Conclusion: In patients undergoing TAVI, being female, high BMI, NYHA class III/IV, atrial fibrillation, albumin levels, and cancer metastasis were factors associated with mortality. Meanwhile, active cancer without metastasis was not associated with increased mortality rates. These findings would help clinical decision-making by patients and physicians.Clinical trial registration: UMIN000031133.

Keywords: AS, aortic stenosis; CI, confidence interval; CT, computed tomography; Cancer; Carcinoma; HR, hazard ratio; Malignancy; Mortality; NYHA, New York Heart Association; SAVR, surgical aortic valve replacement; TAVI, transcatheter aortic valve implantation; Transcatheter aortic valve replacement.

PubMed Disclaimer

Conflict of interest statement

Dr Takamisawa is a clinical proctor of Edwards Lifesciences and Medtroic. The other authors have no conflict of interest regarding this article.

Figures

Fig. 1
Fig. 1
. Treatment policy of patients with active cancer. Therapy aiming to extend survival was defined as radical therapy, and that aiming to alleviate symptoms was defined as palliative therapy.
Fig. 2
Fig. 2
. Patient survival estimates, stratified by cancer status: non-metastatic cancer vs. metastatic cancer vs. non-cancer group. TAVI indicates transcatheter aortic valve implantation.
See this image and copyright information in PMC

References

    1. Smith C.R., Leon M.B., Mack M.J., Miller D.C., Moses J.W., Svensson L.G., et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N. Engl. J. Med. 2011;364:2187–2198. - PubMed
    1. Leon M.B., Smith C.R., Mack M.J., Makkar R.R., Svensson L.G., Kodali S.K., et al. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. N. Engl. J. Med. 2016;374:1609–1620. - PubMed
    1. Mack M.J., Leon M.B., Thourani V.H., Makkar R., Kodali S.K., Russo M., et al. Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients. N. Engl. J. Med. 2019;380:1695–1705. - PubMed
    1. Fischer-Rasokat U., Renker M., Liebetrau C., Weferling M., Rolf A., Doss M., Möllmann H., Walther T., Hamm C.W., Kim W.-K., Erdoes G. Outcome of patients with heart failure after transcatheter aortic valve implantation. PLoS ONE. 2019;14(11):e0225473. - PMC - PubMed
    1. Watanabe Y., Kozuma K., Hioki H., Kawashima H., Nara Y., Kataoka A., et al. Comparison of Results of Transcatheter Aortic Valve Implantation in Patients With Versus Without Active Cancer. Am. J. Cardiol. 2016;118:572–577. - PubMed