Surgical Aortic Valve Replacement in Cancer Survivors with Severe Symptomatic Aortic Valve Disease: A Retrospective Single-Center Observational Study

TL;DR

Cancer survivors with severe aortic valve disease can safely undergo heart surgery, but those with lung cancer have worse long-term survival.

Contribution

This study provides insights into the outcomes of cancer survivors undergoing surgical aortic valve replacement.

Findings

Cancer survivors had comparable surgical outcomes but reduced long-term survival by about one year.

Lung cancer and a short interval between cancer treatment and surgery were key drivers of poor survival.

Prior cancer was a minor predictor of long-term mortality compared to other factors.

Abstract

Because of improved prognoses, cancer survivors with symptomatic aortic valve disease can be referred for cardiac surgery. However, the postoperative outcome of patients with this complex condition is uncertain. In a retrospective monocentric series totaling 2500 patients, 388 cancer survivors were compared with aortic valve patients without prior cancer. The referral increased over time, and cancer survivors were more often male and had more kidney disease but less pulmonary disease. Preoperative severity of heart disease, complexity of surgery, rate of adverse events, 30-day mortality, and need for resources were comparable. Long-term survival was significantly decreased by about one year and was driven mostly by an interval between cancer treatment and cardiac surgery of less than 5 years and lung cancer lethality. Prior malignancy was the least important of the ten identified predictors. For patients with lung cancer, the outcome is poor.

Background/Objectives: Cancer survivors can develop heart conditions such as aortic valve disease because of age and other shared risk factors. If this valve condition becomes symptomatic, the prognosis is poor if the valve is not replaced. Surgical aortic valve replacement (SAVR) is one mode of treatment. Methods: Of 2500 consecutive patients who underwent SAVR with a biological valve, 388 patients were cancer survivors. They were compared for preoperative characteristics, operative parameters, postoperative adverse events, need for resources, and long-term survival. For the latter, the six most common tumors (prostate, breast, colorectal, bladder, pulmonary, and hematologic) and the effect of the interval between cancer treatment and cardiac surgery were scrutinized. Results: Cancer increased significantly over time. Pulmonary and kidney disease differed between the groups, but cardiac comorbid conditions did not. Operative parameters, early adverse events, and need for resources did not differ. Median survival time was significantly reduced in cancer survivors: 104 (97–112) versus 119 (116–122) months, and this was driven by an interval of less than 5 years and prior lung cancer. Prior cancer was the least important of ten predictors for long-term mortality. Conclusions: The outcome of cancer survivors after SAVR is acceptable. For patients with pulmonary cancer, the outcome is poor.

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