Affiliation:
1. Harrington Heart and Vascular Institute Case Western Reserve University Cleveland OH
2. Cardio‐Oncology Program Division of Cardiology Ohio State University Columbus OH
3. National Heart, Lung, and Blood Institute Bethesda MD
4. Division of Cardiology University of North Carolina Chapel Hill NC
5. Division of Epidemiology UNC Gillings School of Global Public Health Chapel Hill NC
6. Division of Cardiac Surgery Department of Surgery University Hospitals Cleveland Medical Center Cleveland OH
7. Division of Cardiology Michael E. DeBakey VA Hospital Baylor College of Medicine Houston TX
8. Cancer Control Program Department of Medicine Ohio State University Comprehensive Cancer Center Columbus OH
Abstract
Background
Patients with cancer and severe aortic stenosis are often ineligible for surgical aortic valve replacement (
SAVR
). Patients with cancer may likely benefit from emerging transcatheter aortic valve replacement (
TAVR
), given its minimally invasive nature.
Methods and Results
The
US
‐based National Inpatient Sample was queried between 2012 and 2015 using
International Classification of Diseases, Ninth Revision, Clinical Modification
(
ICD‐9‐CM
), codes to identify all hospitalized adults (aged ≥50 years), who had a primary diagnosis of aortic stenosis. We examined the effect modification of cancer on the relative use rate, outcomes, and dispositions associated with propensity‐matched cohort
TAVR
versus
SAVR
. Overall, 47 295
TAVRs
(22.6% comorbid cancer) and 113 405
SAVRs
(15.2% comorbid cancer) were performed among admissions with aortic stenosis between 2012 and 2015. In the year 2015, patients with cancer saw relatively higher rates of
TAVR
use compared with
SAVR
(relative use rate
TAVR
versus relative use rate
SAVR
, 67.8% versus 57.2%;
P
<0.0001). Among patients with cancer,
TAVR
was associated with lower odds of acute kidney injury (odds ratio, 0.64; 95% CI, 0.54–0.75) and major bleeding (odds ratio, 0.44; 95%
CI
, 0.38–0.51]), with no differences in in‐hospital mortality and stroke compared with
SAVR
. In addition,
TAVR
was associated with higher odds of home discharge (odds ratio, 1.92; 95% CI, 1.68–2.19) compared with
SAVR
among patients with cancer. Lower risk of acute kidney injury was noted in cancer versus noncancer (
P
<0.001) undergoing
TAVR
versus
SAVR
in effect modification analysis.
Conclusions
TAVR
use has increased irrespective of cancer status, with a greater increase in cancer versus noncancer. In patients with cancer, there was an association of
TAVR
with lower periprocedural complications and better disposition when compared with patients undergoing
SAVR
.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
17 articles.
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