Two-year survival of patients screened for transcatheter aortic valve replacement with potentially malignant incidental findings in initial body computed tomography

作者：Stachon Peter; Kaier Klaus; Milde Simone; Pache Gregor; Sorg Stefan; Siepe Matthias; von zur Muehlen Constantin; Zirlik Andreas; Beyersdorf Friedhelm; Langer Mathias; Zehender Manfred; Bode Christoph; Reinoehl Jochen

来源：European Heart Journal-Cardiovascular Imaging, 2015, 16(7): 731-737.

DOI：10.1093/ehjci/jev055

• aortic valve stenosis
• aortic valve replacement
• TAVR
• TAVI
• incidental finding
• malignancy
• cancer
• mortality
• computed tomography

Aims Recently, transcatheter aortic valve replacement (TAVR) has evolved as the standard treatment in patients with inoperable aortic valve stenosis. According to TAVR guidelines, body computed tomography (CT) is recommended for pre-procedural planning. Due to the advanced age of these patients, multiple radiological potentially malignant incidental findings (pmIFs) appear in this cohort. It is unknown how pmIFs influence the decision by the heart team to intervene and the mortality.
Methods and results We evaluated in a retrospective single-centre observational study 414 participants screened for TAVR with dual-source CT between October 2010 and December 2012. pmIFs are common and appeared in 18.7% of all patients screened for TAVR. The decision to intervene by TAVR or surgical aortic valve replacement (SAVR) was made by an interdisciplinary heart team and the role of pmIF in decision-making and time to treatment with TAVR or SAVR was analysed, retrospectively. The appearance of a pmIF vs. no pmIF did not significantly influence therapeutic decisions [odds ratio (OR) 1.14; P = 0.835] or time to treatment (91 +/- 152 vs. 61 +/- 109 days, respectively). Several findings, which are highly suspicious for malignancy, were less likely associated with invasive treatment (OR 0.207; P = 0.046). Patient survival was evaluated for at least 2 years until January 2014. Two-year survival of patients after TAVR or SAVR, treated according to the heart team decision, was similar to 75% and independent from the presence of a non-severe (P = 0.923) or severe (P = 0.823) pmIF.
Conclusion The study indicates that frequently occurring radiologic pmIF did not influence 2-year survival after a decision to intervene was made by an interdisciplinary heart team.

• 出版日期2015-7