TAVR ‘viable alternative’ for patients with prior chest radiation therapy
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Among adults with severe aortic stenosis who underwent transcatheter aortic valve replacement, those who received prior chest radiation therapy experienced no differences in clinical outcomes compared with those who did not, data show.
Patients with prior chest radiation therapy may develop aortic stenosis at an earlier age than is typical, thought to result from acceleration in fibrocalcific deposition secondary to fibroblast activation, Bibhu D. Mohanty, MD, of the department of cardiovascular sciences at the University of South Florida Morsani College of Medicine, and colleagues wrote in Catheterization and Cardiovascular Interventions. Despite their younger age, these patients are considered poor surgical candidates due to the development of “hostile chest,” a risk descriptor including thoracic scarring and vascular calcification. Studies have shown chest radiation therapy is associated with worse long‐term survival after cardiac or valvular surgery, the researchers wrote.
“The expansion of TAVR to lower risk populations with aortic stenosis has driven investigation of its utility in unique patient subsets,” Mohanty and colleagues wrote. “In this context, TAVR may offer an alternative option for the treatment of severe symptomatic aortic stenosis in patients with prior chest radiation therapy. Yet, there is lack of high‐quality data and long‐term outcomes analysis to support the use of TAVR in this patient population.”
Mohanty and colleagues analyzed data from patients with prior chest radiation therapy (n = 64) and without (n = 3,923) participating in the PARTNER 2 trial. All enrolled patients had severe aortic stenosis and NYHA class II or greater symptoms and underwent TAVR with a balloon-expandable valve system (Sapien family of products, Edwards Lifesciences). The primary outcome was a composite of all‐cause death and any stroke at 2 years.
Secondary outcomes included rehospitalization, prosthetic valve dysfunction, reintervention, MI, bleeding, vascular complications, acute kidney injury, coronary obstruction and new pacemaker implant in‐hospital, at 30 days and 2 years.
Researchers did not observe between-group differences in the primary outcome between patients with and without prior chest radiation therapy (30.7% vs. 27%, respectively; HR = 1.08; 95% CI, 0.66-1.77; P = .75). Rates of MI, vascular complications, acute kidney injury or new pacemaker implant after TAVR did not differ between groups.
The rate of immediate reintervention with a second valve for aortic regurgitation after TAVR was higher among patients with prior chest radiation therapy (4.7% vs. 0.7%; P < .0001); however, researchers observed no further difference during 2 years of follow‐up after discharge from the index‐procedure hospitalization.
“Despite historical concern for poor outcomes with surgery, these patients demonstrated similar long‐term outcomes following TAVR compared with those of patients not previously treated with chest radiation therapy,” the researchers wrote. “These results suggest that TAVR is a viable alternative for patients with severe symptomatic aortic stenosis who had prior chest radiation therapy.”
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