Surgical Versus Transcatheter Aortic Valve Replacement in Patients With Malignancy.
BACKGROUND
Patients with aortic stenosis (AS) and malignancy experience poor clinical outcomes with challenging decisions regarding aortic valve replacement (AVR). We sought to compare the outcomes of transcatheter (TAVR) versus surgical (SAVR) AVR in patients with AS and malignancy.


METHODS
Based on the Nationwide Readmission Database, we compared all patients with malignancy who underwent isolated SAVR vs. TAVR in 2016 for severe AS. We performed univariate and multivariate analyses for baseline characteristics and clinical outcomes. A total of 2566 patients were included, 1952 (76%) had TAVR and the remaining 614 (24%) had isolated SAVR. Patients who underwent TAVR were older (82 vs 72 years, p < .001), had more metastasis (19 vs 14%, p = .004), heart failure (72% vs 34%, p < .001), coronary artery disease (72% vs 52%, p < .001), anemia (28% vs 22%, p = .006), chronic lung (30% vs 22%, p < .001) and renal disease (35% vs 14%, p < .001), and shorter length of stay (3 vs 7 days, p < .001).


RESULTS
In multivariate regression, TAVR and SAVR had similar in-patient mortality (HR = 1.08; 95%CI 0.61 ̶ 1.94) and 30-day readmission (HR = 1.26; 95%CI 0.95 ̶ 1.67). TAVR was associated with lower vascular complications (HR = 0.59; 95%CI 0.41 ̶ 0.86), acute deep venous thrombosis (HR = 0.25, 95%CI 0.1 ̶ 0.59), acute kidney injury (HR = 0.24, 95%CI 0.17 ̶ 0.33), blood transfusion (HR = 0.22, 95%CI 0.16 ̶ 0.3), cardiogenic shock (HR = 0.48, 95%CI 0.26 ̶ 0.89), and respiratory complications (HR = 0.26, 95%CI 0.2 ̶ 0.35).


CONCLUSIONS
In patients with malignancy, TAVR is a viable and safe option compared to SAVR with better clinical outcomes, especially thromboembolic events.
['Kadri|Amer N|AN|', 'Bernardo|Marie|M|', 'Assar|Saba Z|SZ|', 'Werns|Steven|S|', 'Abbas|Amr E|AE|']
D001021:Aortic Valve D001024:Aortic Valve Stenosis D019918:Heart Valve Prosthesis Implantation D017052:Hospital Mortality D006801:Humans D009369:Neoplasms D011183:Postoperative Complications D012307:Risk Factors D013997:Time Factors D065467:Transcatheter Aortic Valve Replacement D016896:Treatment Outcome
Malignancy Aortic stenosis TAVR SAVR Treatment outcomes Valvular heart disease