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The Onco-cardiologist Dilemma: to Implant, to Defer, or to Avoid Transcatheter Aortic Valve Replacement in Cancer Patients with Aortic Stenosis?

  • Cardio-Oncology (SA Francis and RB Morgan, Section Editors)
  • Published:
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Abstract

Purpose of Review

Aging is associated with an increased prevalence of both cancer and heart disease. The progression of aortic valve calcification to aortic stenosis may be accelerated by both cardiovascular risk factors and cancer treatments, such as radiotherapy with mediastinal involvement. Symptomatic aortic stenosis is occasionally diagnosed in cancer patients undergoing cardiovascular evaluation; likewise, cancer is often recognized during assessment preceding aortic valve interventions. In these complex cases, physicians face difficult treatment decisions. Due to a myriad of clinical presentations of cancer and valve disease, specific guidelines for this patient population are not currently in place. Management is currently based on clinical judgment, on an individual basis.

Recent Findings

Patients with cancer in remission or with a favorable prognosis should be treated according to current cardiovascular guidelines. In these patients, aortic valve replacement can be performed either by surgery or transcatheter. Significant challenges arise in patients with active cancer, especially those receiving anti-cancer treatment. Recent data suggests that these patients can be offered aortic valve replacement, with a trend of favoring the transcatheter route in order to minimize perioperative risk and complications associated with major surgery. Patients with advanced cancer and severe aortic stenosis should be offered palliative care and can benefit from aortic balloon valvuloplasty if indicated. Modern cancer treatments associated with improved long-term prognosis may allow the appropriate cure of aortic stenosis.

Summary

We discuss the protocol, outcomes, and evolving recommendations of aortic valve replacement in cancer patients with aortic stenosis.

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Authors and Affiliations

  1. Department of Cardiology, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

    Serban Mihai Balanescu & Teodora Donisan

  2. Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX, 77030, USA

    Dinu Valentin Balanescu, Teodora Donisan, Nicolas Palaskas, Juan Lopez-Mattei, Saamir Hassan, Peter Kim & Cezar Iliescu

  3. UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA

    Eric H. Yang

  4. Bahcesehir University, School of Medicine, Istanbul, Turkey

    Mehmet Cilingiroglu

  5. Florida Hospital Pepin Heart Institute, Tampa, FL, USA

    Konstantinos Marmagkiolis

  6. Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston, Memorial Hermann Hospital, Houston, TX, USA

    Biswajit Kar

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  1. Serban Mihai Balanescu
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Serban Mihai Balanescu, Dinu Valentin Balanescu, Teodora Donisan, Eric H. Yang, Nicolas Palaskas, Juan Lopez-Mattei, Saamir Hassan, Peter Kim, Mehmet Cilingiroglu, Konstantinos Marmagkiolis, Biswajit Kar, and Cezar Iliescu declare that they have no conflict of interest.

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Balanescu, S.M., Balanescu, D.V., Donisan, T. et al. The Onco-cardiologist Dilemma: to Implant, to Defer, or to Avoid Transcatheter Aortic Valve Replacement in Cancer Patients with Aortic Stenosis?. Curr Cardiol Rep 21, 83 (2019). https://doi.org/10.1007/s11886-019-1166-0

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