Abstract 358: Meta-analysis Comparing the Results of Transcatheter Aortic Valve Replacement in Severe Aortic Stenosis in Patients With and Without Prior Chest Radiation Therapy

Objective: Cancer survivors with symptomatic severe aortic stenosis and a history of chest radiation therapy represent a complex and challenging cohort for management. Here we present a meta-analysis and systematic review of the literature regarding the outcomes of transcatheter aortic valve replacement (TAVR) in patients with prior chest radiation therapy (XRT group) versus patients without prior chest radiation therapy (non-XRT group). Following a comprehensive database search filtering through 129 relevant studies 4 most robust studies were included for in-depth analysis.

Methods and Results: Articles were screened from Scopus, PubMed, and Cochrane Library databases (updated through December 31, 2019). Rev Man 5.3 was used for data analysis. We included four observational studies (Dijos M et al: 2015, Bouleti C et al: 2016, Agrawal N et al: 2019, Gajanana D et al: 2019). The primary outcomes measured are 30-day mortality, cardiovascular mortality, major bleeding event, post-procedural pacemaker implantation, and strokes / transient ischemic attacks.The pooled random effect analysis demonstrated no statistically significant difference in two groups undergoing TAVR in 30-day mortality, cardiovascular mortality, post-procedure major bleed event, and permanent pacemaker implantation with an odds ratio of 1.44 [95% CI: 0.57, 3.67]; 1.42 [95% CI: 0.50, 4.04]; 1.29 [95% CI: 0.71, 2.34] and 1.31 [95% CI: 0.61, 2.81] respectively.Statistically significant higher risk of stoke/transient ischemic attacks in non-XRT group as compare to XRT group undergoing transcatheter aortic valve replacement with an odds ratio of 2.34 [95% CI: 1.18, 4.62].

Conclusion: XRT group undergoing TAVR have few post-procedural complications, with rates similar to those of non-XRT group undergoing TAVR. Although, our study showed statistically significant higher risk of stroke/ transient ischemic attach in non-XRT group as compare to XRT group. Larger, multicenter studies are needed to assess long-term outcomes of TAVR patients with prior chest radiation.