One thousand patients with symptomatic aortic valve disease and malignancy: Can they withstand aortic valve replacement?

Wilhelm Peter Mistiaen

Abstract


Aortic valve disease is the third most common cardiovascular disease among the elderly. Once it becomes symptomatic, the short-term prognosis is poor. These patients often have comorbid conditions such as malignancies. The main question is to identify if such patients can undergo aortic valve replacement (AVR) which is the only way to improve prognosis. One thousand patients underwent valve replacement in a 7-year time span. A retrospective file study was performed to evaluate the presence of malignancies, other pre-operative comorbid conditions, severity of heart diseases, operative data and post-operative complications. Statistical analyses were performed using chi-square and Mann-Whitney U-test. Malignancies were found in 137 patients. With respect to comorbid conditions, there were no significant differences between cancer and non-cancer patients, except for a higher mean transvalvular gradient (P = 0.027) and less obesity (P = 0.033) or hyperlipidemia (P = 0.052). Post-operative results showed a trend of delirium cases in cancer patients (P = 0.071), and there was a borderline shorter length of hospital stay (P = 0.087). There were no significant differences in other post-operative complications or mortality, which was 5.8% for cancer patients and  4.5% for non-cancer patients (P = 0.704). Elderly patients with a history of malignancies can withstand major cardiac surgeries such as AVR. They did not exhibit comorbid conditions or major post-operative complications. Mortality was also comparable. If such patients have an acceptable cancer prognosis, they should not be denied the life-saving AVR. However, the decision to offer AVR should be made by a multidisciplinary team involving cardiologists, cardiac surgeons and oncologists. Once such decision is made, it should not be delayed.

Keywords


Aortic valve replacement; malignancy; 30-day mortality; 30-day complication rate

Full Text:

PDF

References


Baumgartner H. Aortic stenosis: Medical and surgical management. Heart 2005; 91(11): 1483–1488. doi: 10.1136/hrt.2004.056176.

Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: A population-based study. Lancet 2006; 368(9540): 1005–1011. doi: 10.1016/S0140-6736(06)69208-8.

Bach DS, Radeva JI, Birnbaum HG, Fournier AA, Tuttle EG. Prevalence, referral patterns, testing, and surgery in aortic valve disease: Leaving women and elderly patients behind? J Heart Valve Dis 2007; 16(4): 362–369.

Carabello BA. Evaluation and management of patients with aortic stenosis. Circulation 2002; 105: 1746–1750. doi: 10.1161/01.CIR.0000015343.76143.13.

Yurek LA, Jakub KE, Menacho MM. Severe symptomatic aortic stenosis in older adults: Pathophysiology, clinical manifestations, treatment guidelines, and transcatheter aortic valve replacement (TAVR). J Gerontol Nurs 2015; 41(6): 8–13. doi: 10.3928/00989134-20150414-02.

Clark MA, Arnold SV, Duhay FG, Thompson AK, Keyes MJ, Svensson LG, Bonow RO, Stockwell BT, Cohen DJ. Five-year clinical and economic outcomes among patients with medically managed severe aortic stenosis: Results from a Medicare claims analysis. Circ Cardiovasc Qual Outcomes 2012; 5(5): 697–704. doi: 10.1161/CIRCOUTCOMES.112.966002.

Mistiaen WP, Van Cauwelaert P, Muylaert P, Wuyts F, Harrisson F, Bortier H. Effect of prior malignancy on survival after cardiac surgery. Ann Thorac Surg 2004; 77(5): 1593–1597. doi: 10.1016/j.athoracsur.2003.08.049.

Mistiaen WP, Van Cauwelaert P, Muylaert P, Van Hove M, Su S, Harrisson F, Bunarto J, Delaruelle J, Bortier H. Determinants of survival after aortic valve replacement as treatment for symptomatic aortic valve disease in elderly. J Heart Valve Dis 2001; 10(3): 354–360.

Stachon P, Kaier K, Milde S, Pache G, Sorg S, Siepe M, von zur Mühlen C, Zirlik A, Beyersdorf F, Langer M, Zehender M, Bode C, Reinöhl J. Two-year survival of patients screened for transcatheter aortic valve replacement with potentially malignant incidental findings in initial body computed tomography. Eur Heart J Cardiovasc Imaging 2015; 16(7): 731–737. doi: 10.1093/ehjci/jev055.

Chang ASY, Smedira N, Chang CL, Benavides MM, Myhre U, Feng J, Blackstone EH, Lytle BW. Cardiac surgery after mediastinal radiation: Extent of exposure influences outcome. J Thorac Cardiovasc Surg 2007; 133(2): 405–413. doi: 10.1016/j.jtcvs.2006.09.041.

Cella L, Liuzzi R, Conson M, Torre G, Caterino M, De Rosa N, Picardi M, Camera L, Solla R, Farella A, Salvatore M, Pacelli R. Dosimetric predictors of asymptomatic heart valvular dysfunction following mediastinal irradiation for Hodgkin’s lymphoma. Radiother Oncol 2011; 101(2): 316–321. doi: 10.1016/j.radonc.2011.08.040.

Chan J, Rosenfeldt F, Chaudhuri K, Marasco S. Cardiac surgery in patients with a history of malignancy: Increased complication rate but similar mortality. Heart Lung Circ 2012; 21(5):255–259. doi: 10.1016/j.hlc.2012.02.004.

Carrascal Y, Gualis J, Arévalo A, Fulquet E, Flórez S, Rey J, Echevarría JR, Di Stefano S, Fiz L. Cirugía cardiaca con circulación extracorpórea en pacientes oncológicos: Influencia en la morbimortalidad quirúrgica y la supervivencia (Spanish) [Cardiac surgery with extracorporeal circulation in cancer patients: Influence on surgical morbidity and mortality and on survival]. Rev Esp Cardiol 2008; 61(4): 369–375. doi: 10.1157/13117728.

van Straten AH, Safari M, Ozdemir HI, Elenbaas TW, Hamad MA. Does the body mass index predict mortality after isolated aortic valve replacement? J Heart Valve Dis2013; 22(5): 608–614.

Van Rompaey B, Schuurmans MJ, Shortridge-Baggett LM, Truijen S, Bossaert L. Risk factors for intensive care delirium: A systematic review. Intensive Crit Care Nurs 2007; 24(2): 98–107. doi: 10.1016/j.iccn.2007.08.005.

Bucerius J, Gummer JF, Borger MA, Walther T, Doll N, Falk V, Schmitt DV, Mohr FW. Predictors of delirium after cardiac surgery delirium: Effect of beating-heart (off-pump) surgery. J Thorac Cardiovasc Surg 2004; 127(1): 57–164. doi: 10.1016/S0022-5223(03)01281-9.

Samuels LE, Kaufman MS, Morris RJ, Styler M, Brockman SK. Open heart surgery in patients with chronic lymphocytic leukemia. Leukemia Res 1999; 23(1): 71–75. doi: 10.1016/S0145-2126(98)00126-X.

Potapov EV, Zurbrügg HR, Herzke C, Srock S, Riess H, Sodian R, Hübler S, Hetzer R. Impact of cardiac surgery using cardiopulmonary bypass on course of chronic lymphatic leukemia: A case-control study. Ann Thorac Surg 2002; 74(2): 384–389. doi: 10.1016/S0003-4975(02)03678-0.

Fecher AM, Birdas TJ, Haybron D, Papasavas PK, Evers D, Caushaj PF. Cardiac operations in patients with hematologic malignancies. Eur J Cardiothorac Surg 2004; 25(4): 537–540. doi: 10.1016/j.ejcts.2003.12.006.

Yusuf SW, Sarfaraz A, Durand JP, Swafford J, Daher IN. Management and outcomes of severe aortic stenosis in cancer patients. Am Heart J 2011; 161(6): 1125–1132. doi: 10.1016/j.ahj.2011.03.013.

Wethal Y, Lund M-B, Edvardsen T, Fossa SD, Pripp AH, Holte H, Kjekshus J, Fosså A. Valvular dysfunction and left ventricular changes in Hodgkin’s lymphoma survivors. A longitudinal study. Brit J Cancer 2009; 101: 575–581. doi: 10.1038/sj.bjc.6605191.




DOI: http://dx.doi.org/10.30564/amor.v2i1.33

Refbacks

  • There are currently no refbacks.


Copyright (c) 2018 Wilhelm Peter Mistiaen

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.