TRANSCATHETER VERSUS SURGICAL AORTIC VALVE REPLACEMENT IN PATIENTS WITH PRIOR HISTORY OF CHEST RADIATION

Introduction: A history of malignancy is incorporated in the Society of Thoracic Surgeons (STS) Score to assess presurgical risk in patients undergoing surgical aortic valve replacement (SAVR), however data on the prognostic importance in those undergoing TAVR remains limited. Methods: The National Inpatient Sample Database was queried from 2012 to 2017 to identify patients who underwent TAVR using International Classification of Diseases (ICD) 9 and 10 procedure codes. These patients were classified into those who had a history of malignancy or not using ICD 9 and 10 diagnostic codes. Results: There were 24,615 patients who underwent TAVR, of these 4,735 patients had a prior history of malignancy whereas 19,880 patients had no prior history of malignancy. Patients with a history of malignancy were older than those without (81.1±7.9 vs. 80.1± 6.7 years old, p<0.001). Baseline characteristics are shown in Table 1. Patients with a history of malignancy had similar rates of post-TAVR pacemaker implantation (7.6% vs. 6.8%,p=0.05), deep vein thrombosis/pulmonary embolism (2.8% vs.3.1%, p=0.231), paravalvular leak (0.9% vs. 1.1%, p=0.312) and cardiogenic shock (0.3% vs. 0.3%, p=0.828) as those without. The occurrence of post TAVR ischemic strokes were higher in those without a history of malignancy ( 4.8% vs. 3.6%, p<0.001). Using a multivariate logistic regression model to adjust for confounding factors such as age, gender, hypertension, diabetes, heart failure, chronic kidney disease and coronary artery disease, a history of malignancy was predictive of decreased odds of death in patients undergoing TAVR (odds ratio: 0.69, 95% confidence interval 0.53-0.90, p=0.007). Conclusions: In patients with severe symptomatic AS and a history of malignancy, TAVR appears safe with comparable in-hospital outcomes. A history of malignancy should not preclude TAVR in patients with severe symptomatic AS, however larger studies are needed to confirm this finding.

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Bioprosthetic aortic valve haemodynamic deterioration secondary to a thrombus

BMJ Case Reports ◽

10.1136/bcr-2019-233400 ◽

2020 ◽

Vol 13 (9) ◽

pp. e233400

Author(s):

Martin A Chacon-Portillo ◽

Bishnu Dhakal ◽

Rajesh Janardhanan

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Severe Aortic Stenosis ◽

Artery Bypass ◽

Shortness Of Breath ◽

Coronary Angiogram ◽

Surgical Aortic Valve Replacement ◽

History Of ◽

Root Size

A 77-year-old man with a history of coronary artery bypass grafting and surgical aortic valve replacement for severe aortic stenosis 2 years prior presented with exertional chest pain and shortness of breath. The patient underwent a thorough initial evaluation including a transthoracic echocardiogram and coronary angiogram without significant findings. One month later the patient presented with worsened symptoms and a repeat echocardiogram showed an increased mean aortic valve gradient of 87 mm Hg. The patient had to undergo reoperation for a surgical aortic valve replacement and was found to have an aortic bioprosthetic valve thrombus. This case suggests a mismatch between the aortic prosthesis and the patient’s aortic root size.

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