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- Title
Outcomes of patients with active cancer after transcatheter aortic valve replacement: an updated meta-analysis.
- Authors
Felix, Nicole; Nogueira, Alleh; Carvalho, Pedro E. P.; Costa, Thomaz Alexandre; Tramujas, Lucas; Generoso, Giuliano; Feldman, Stephanie; Garot, Philippe; de Farias, Maria do Carmo Andrade Duarte
- Abstract
Background: Patients with active cancer and aortic stenosis may be under-referred for valve interventions due to concerns over a prohibitive risk. However, whether active cancer impacts outcomes after transcatheter aortic valve replacement (TAVR) remains unknown. Methods: We searched PubMed, Embase, and Cochrane Library in December 2023 for studies comparing the post-TAVR outcomes of patients with versus without active cancer. We pooled odds ratios (OR) and adjusted hazard ratios (aHR) with 95% confidence intervals (CI) applying a random-effects model. Statistical analyses were performed in R version 4.3.2. Results: We included nine observational studies analyzing 133,906 patients, of whom 9,792 (7.3%) had active cancer. Compared with patients without cancer, patients with active cancer had higher short- (OR 1.33; 95% CI 1.15–1.55; p < 0.001) and long-term mortality (OR 2.29; 95% CI 1.80–2.91; p < 0.001) rates, not driven by cardiovascular mortality (OR 1.30; 95% CI 0.70–2.40; p = 0.40), and higher major bleeding rates (OR 1.66; 95% CI 1.15–2.42; p = 0.008). The higher mortality rate was sustained in an adjusted analysis (aHR 1.77; 95% CI 1.34–2.35; p < 0.001). There was no significant difference in cardiac, renal, and cerebral complications at a follow-up ranging from 180 days to 10 years. Conclusion: Patients with active cancer undergoing TAVR had higher non-cardiovascular mortality and bleeding rates, with comparable incidences of other complications. This highlights the need for a shared decision and appropriate patient selection considering cancer type, staging, bleeding risk, and optimal timing for intervention.
- Subjects
CARDIOVASCULAR disease related mortality; MEDICAL information storage &; retrieval systems; PATIENT selection; SCIENTIFIC observation; TREATMENT effectiveness; CANCER patients; CARDIO-oncology; META-analysis; SURGICAL blood loss; MULTIVARIATE analysis; DESCRIPTIVE statistics; HEART valve prosthesis implantation; SYSTEMATIC reviews; MEDLINE; ODDS ratio; AORTIC stenosis; MEDICAL databases; TUMORS; ONLINE information services; CONFIDENCE intervals; COMPARATIVE studies; TUMOR classification; DATA analysis software; QUALITY assurance; TIME
- Publication
Cardio-Oncology, 2024, Vol 10, Issue 1, p1
- ISSN
2057-3804
- Publication type
Article
- DOI
10.1186/s40959-024-00256-8