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Transcatheter aortic valve intervention in patients with cancer
  1. Douglas Leedy1,
  2. David M Elison1,
  3. Francisco Farias2,
  4. Richard Cheng1,
  5. James M McCabe1
  1. 1Cardiology, University of Washington Medical Center, Seattle, Washington, USA
  2. 2Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
  1. Correspondence to Dr James M McCabe, University of Washington, Seattle, Washington, USA; jmmccabe{at}


The prevalence of concurrent cancer and severe aortic stenosis (AS) is increasing due to an ageing population. In addition to shared traditional risk factors for AS and cancer, patients with cancer may be at increased risk for AS due to off-target effects of cancer-related therapy, such as mediastinal radiation therapy (XRT), as well as shared non-traditional pathophysiological mechanisms. Compared with surgical aortic valve replacement, major adverse events are generally lower in patients with cancer undergoing transcatheter aortic valve intervention (TAVI), especially in those with history of mediastinal XRT. Similar procedural and short-to-intermediate TAVI outcomes have been observed in patients with cancer as compared with no cancer, whereas long-term outcomes are dependent on cancer survival. Considerable heterogeneity exists between cancer subtypes and stage, with worse outcomes observed in those with active and advanced-stage disease as well as specific cancer subtypes. Procedural management in patients with cancer poses unique challenges and thus requires periprocedural expertise and close collaboration with the referring oncology team. The decision to ultimately pursue TAVI involves a multidisciplinary and holistic approach in assessing the appropriateness of intervention. Further clinical trial and registry studies are needed to better appreciate outcomes in this population.

  • heart valve prosthesis implantation
  • transcatheter aortic valve replacement
  • aortic valve stenosis
  • heart valve prosthesis

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  • Twitter @djleedy, @RichardKCheng2, @jamiemccabeMD

  • Contributors All authors have read and approved the manuscript. All authors contributed significantly to the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JMcC receives honoraria and is on the advisory boards of Boston Scientific, Edwards Lifesciences and Medtronic and has equity in ConKay Medical and Excision Medical. RC is an Associate Editor of BMJ Heart.

  • Provenance and peer review Commissioned; internally peer reviewed.