Aortic valve stenosis and cancer: a common and complex association

ABSTRACT

Introduction. The prevalence of aortic valve stenosis (AS) and malignancy are both high, especially in elderly people and in developed countries. These two conditions frequently coexist and share the same risk factors as atherosclerotic disease.

Area covered. The progression of calcified AS may be accelerated by both cardiovascular risk factors and cancer treatments, such as radiotherapy. The standard treatment for symptomatic severe AS is surgical aortic valve replacement; however, in cancer patients, transcatheter implantation may be preferred as they are often at high-risk for cardiac surgery. In patients with AS and cancer, physicians may face difficult treatment decisions.

To date, there is limited information on the impact of malignancy on outcomes in patients with severe AS; hence, there is no established treatment policy.

Expert Opinion. Treating clinicians must integrate complex information about the severity of valve disease and expected cardiac outcomes with information regarding the cancer prognosis and the need for specific treatment, including surgery. Other comorbidities, age and frailty also contribute to decision-making about whether, when, and how to perform aortic valve replacement.

KEYWORDS:

• Aortic stenosis
• cancer
• valve replacement
• transcatheter valve implantation
• balloon aortic valvuloplasty

Article highlights

• Hemodynamically significant aortic valve stenosis and cancer are frequently observed in the same patient, often requiring difficult therapeutic choices.

• Aortic stenosis and cancer share several risk factors, such as hypertension, obesity, diabetes, smoking, dyslipidemia and inflammation. Accordingly, the detection and appropriate management of these risk factors should allow not only a reduction in aortic stenosis incidence and progression but also a potential reduction in cancer incidence.

• Severe symptomatic aortic valve stenosis in patients with cancer requires a careful assessment in order to select the appropriate therapeutic choices and their timing (valve-treatment first versus cancer-treatment first).

• Concomitant cardiovascular problems, such as left ventricular dysfunction, coronary artery disease, other valve abnormalities (for example, mitral regurgitation) should be promptly assessed, before the treatment of aortic stenosis

• Comorbidities, such as obesity, diabetes, anemia, kidney or lung disease and others, should be identified since they contributed to the risk of different treatments and to the expected outcome.

• Several therapeutic options are currently available for aortic valve stenosis, such surgical valve replacement, transcatheter valve implantation, balloon valvuloplasty, or medical therapy. Use of one of these versus the others should be decided on a case-by-case approach, depending on cancer stage and associated treatment, expected outcome, comorbidities, and frailty.

• A strict collaboration between Oncologist and Cardiologist is needed.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.