TAVR in Cancer Patients: Comprehensive Review, Meta-Analysis, and Meta-Regression
Objectives: This study sought to systematically analyze the available clinical evidence on TAVR therapy in cancer patients with symptomatic severe AS.Background: Aortic stenosis is the most common valvular heart disease in the world. TAVR has expanded the treatment options for this lethal disease pr...
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doaj-2aed5426723644899c552fca9ba12edc2021-08-04T05:27:15ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2021-08-01810.3389/fcvm.2021.641268641268TAVR in Cancer Patients: Comprehensive Review, Meta-Analysis, and Meta-RegressionKonstantinos Marmagkiolis0Dominique J. Monlezun1Mehmet Cilingiroglu2Cindy Grines3Joerg Herrmann4Konstantinos Pavlos Toutouzas5Ismail Ates6Cezar Iliescu7University of Texas MD Anderson Cancer Center, Houston, TX, United StatesUniversity of Texas MD Anderson Cancer Center, Houston, TX, United StatesUniversity of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Medicine, Wayne State University, Detroit, MI, United StatesMayo Clinic, Rochester, MN, United StatesDepartment of Cardiology, National and Kapodistrian University of Athens, Athens, GreeceDepartment of Cardiology, Bahçeşehir University, Istanbul, TurkeyUniversity of Texas MD Anderson Cancer Center, Houston, TX, United StatesObjectives: This study sought to systematically analyze the available clinical evidence on TAVR therapy in cancer patients with symptomatic severe AS.Background: Aortic stenosis is the most common valvular heart disease in the world. TAVR has expanded the treatment options for this lethal disease process. The safety and efficacy of TAVR in cancer patients has not yet been reliably established. We thus conducted the largest known multi-center meta-analysis on TAVR and cancer status.Methods: We performed a literature search using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from January 2015 to 2020. Studies that compared the use of TAVR in patients with severe symptomatic aortic stenosis and cancer against patients without cancer were included. Meta-regression was also conducted to determine if common clinical factors modified the possible association between cancer status and TAVR mortality.Results: Five studies with 11,129 patients in the cancer group and 41,706 patients in the control group met inclusion criteria. The short-term mortality in the cancer group was 2.4% compared with 3.3% in the control group (odds ratio: 0.72, 95% confidence interval: 0.63–0.82; p < 0.0001). The frequency of stroke was 2.4% compared with 2.7% (odds ratio of 0.87, 95% confidence interval: 0.76–0.99; p < 0.04). The frequency of AKI was 14.2% in cancer patients vs. 16.4% (odds ratio of 0.81, 95% confidence interval: 0.76–0.85; p < 0.04). The rates of bleeding and need for new pacemaker implantation were not significantly different. Meta-regression demonstrated there was no significant association modifying.Conclusions: On the basis of the results of this meta-analysis TAVR may be a safe and effective therapeutic option for patients with cancer and symptomatic severe aortic stenosis. Larger, longer, and randomized trials are required to adequately test this above hypothesis.https://www.frontiersin.org/articles/10.3389/fcvm.2021.641268/fullTAVRcancercardio-oncologymeta-analysisaortic stenosis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Konstantinos Marmagkiolis Dominique J. Monlezun Mehmet Cilingiroglu Cindy Grines Joerg Herrmann Konstantinos Pavlos Toutouzas Ismail Ates Cezar Iliescu |
spellingShingle |
Konstantinos Marmagkiolis Dominique J. Monlezun Mehmet Cilingiroglu Cindy Grines Joerg Herrmann Konstantinos Pavlos Toutouzas Ismail Ates Cezar Iliescu TAVR in Cancer Patients: Comprehensive Review, Meta-Analysis, and Meta-Regression Frontiers in Cardiovascular Medicine TAVR cancer cardio-oncology meta-analysis aortic stenosis |
author_facet |
Konstantinos Marmagkiolis Dominique J. Monlezun Mehmet Cilingiroglu Cindy Grines Joerg Herrmann Konstantinos Pavlos Toutouzas Ismail Ates Cezar Iliescu |
author_sort |
Konstantinos Marmagkiolis |
title |
TAVR in Cancer Patients: Comprehensive Review, Meta-Analysis, and Meta-Regression |
title_short |
TAVR in Cancer Patients: Comprehensive Review, Meta-Analysis, and Meta-Regression |
title_full |
TAVR in Cancer Patients: Comprehensive Review, Meta-Analysis, and Meta-Regression |
title_fullStr |
TAVR in Cancer Patients: Comprehensive Review, Meta-Analysis, and Meta-Regression |
title_full_unstemmed |
TAVR in Cancer Patients: Comprehensive Review, Meta-Analysis, and Meta-Regression |
title_sort |
tavr in cancer patients: comprehensive review, meta-analysis, and meta-regression |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Cardiovascular Medicine |
issn |
2297-055X |
publishDate |
2021-08-01 |
description |
Objectives: This study sought to systematically analyze the available clinical evidence on TAVR therapy in cancer patients with symptomatic severe AS.Background: Aortic stenosis is the most common valvular heart disease in the world. TAVR has expanded the treatment options for this lethal disease process. The safety and efficacy of TAVR in cancer patients has not yet been reliably established. We thus conducted the largest known multi-center meta-analysis on TAVR and cancer status.Methods: We performed a literature search using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from January 2015 to 2020. Studies that compared the use of TAVR in patients with severe symptomatic aortic stenosis and cancer against patients without cancer were included. Meta-regression was also conducted to determine if common clinical factors modified the possible association between cancer status and TAVR mortality.Results: Five studies with 11,129 patients in the cancer group and 41,706 patients in the control group met inclusion criteria. The short-term mortality in the cancer group was 2.4% compared with 3.3% in the control group (odds ratio: 0.72, 95% confidence interval: 0.63–0.82; p < 0.0001). The frequency of stroke was 2.4% compared with 2.7% (odds ratio of 0.87, 95% confidence interval: 0.76–0.99; p < 0.04). The frequency of AKI was 14.2% in cancer patients vs. 16.4% (odds ratio of 0.81, 95% confidence interval: 0.76–0.85; p < 0.04). The rates of bleeding and need for new pacemaker implantation were not significantly different. Meta-regression demonstrated there was no significant association modifying.Conclusions: On the basis of the results of this meta-analysis TAVR may be a safe and effective therapeutic option for patients with cancer and symptomatic severe aortic stenosis. Larger, longer, and randomized trials are required to adequately test this above hypothesis. |
topic |
TAVR cancer cardio-oncology meta-analysis aortic stenosis |
url |
https://www.frontiersin.org/articles/10.3389/fcvm.2021.641268/full |
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