Research lettersIncidental detection of malignancy during preprocedural workup for transcatheter aortic valve implantation: A longitudinal cohort study
Section snippets
Study design and population
The study was based on a prospectively collected data from an ongoing registry, which includes consecutive patients undergoing TAVI for severe, symptomatic aortic stenosis at Bern University Hospital in Switzerland. Details of the Bern TAVI registry have been reported previously.3 The study has been approved by the local ethics committee and all patients provided written informed consent for participation. For the purpose of the present study, all patients undergoing TAVI between January 2015
Results
Among 579 patients undergoing CT prior to TAVI between January 2015 and December 2016, 575 were included in the present study. Incidental findings were reported in 365 patients (63.5%). Malignancy was suspected in 116 patients (20.2%) and confirmed in 26 patients (4.5%) (Figure 1). Among patients with incidental malignancy, cancer staging was available in 11 patients (stage I/II: 7 and stage III/IV: 4), while 15 patients refused further investigations for the purpose of staging of disease.
Discussion
The salient findings of this study can be summarized as follows. First, incidental malignancy was detected in 4.5% of patients during pre-evaluation for TAVI. Second, almost one-third of patients with incidentally detected malignancy during pre-TAVI CT died within 1 year after TAVI. The risk of death within 1-year after TAVI was 2.9 times increased compared to patients with no malignancy, and the RMST after TAVI was 16 months shorter compared to patients with no malignancy.
In the present study,
Conclusion
In conclusion, CT-work-up for TAVI exposed previously undetected malignancy in 4.5% of patients. TAVI patients with a new malignancy had a 2.9-fold increased risk of death at 1 year, and a 16 month shorter mean survival time compared to patients with no malignancy.
Funding
No funding.
Conflict of interest
Dr Windecker reports research and educational grants to the institution from Abbott, Amgen, Astra Zeneca, BMS, Bayer, Biotronik, Boston Scientific, Cardinal Health, CardioValve, CSL Behring, Daiichi Sankyo, Edwards Lifesciences, Guerbet, InfraRedx, Johnson & Johnson, Medicure, Medtronic, Novartis, Polares, OrPha Suisse, Pfizer, Regeneron, Sanofi-Aventis, Sinomed, Terumo, V-Wave. Dr Windecker serves as unpaid advisory board member and/or unpaid member of the steering/executive group of trials
Acknowledgments
None.
References (9)
- et al.
Transcatheter aortic valve replacement in oncology patients with severe aortic stenosis
JACC Cardiovasc Interv
(2019) - et al.
Computed Tomography Imaging in the Context of Transcatheter Aortic Valve Implantation (TAVI)/Transcatheter Aortic Valve Replacement (TAVR): An Expert Consensus Document of the Society of Cardiovascular Computed Tomography
JACC Cardiovasc Imaging
(2019) - et al.
Incidental abnormal CT scan findings during transcatheter aortic valve implantation assessment: incidence and implications
Open heart
(2018) - et al.
Incidental findings" during TAVI work-up: more than just an inconvenience
EuroIntervention
(2015)
Cited by (0)
One sentence summary: “Incidental malignancy is detected in 4.5% of patients undergoing workup for TAVI, and is associated with adverse five-year outcome.”
- #
The first two authors contributed equally to this article