Transcatheter aortic valve implantation in a cancer patient denied for surgical aortic valve replacement-a case report.

BACKGROUND: Aortic stenosis is a progressive disease. Symptomatic aortic stenosis has a poor prognosis, which is frequently worse than that of a malignant disease. Cancer patients with severe aortic stenosis may be denied for optimal oncologic treatment because of high operative risk and for aortic valve replacement because of the significant comorbidity itself. In patients treated with medical therapy alone, 1-year-mortality exceeds 50 %.

CASE REPORT: A 71-year-old woman with well-differentiated, surgically treated, ovarian carcinoma and two relapses treated with chemo- and radiotherapy presented with symptomatic severe aortic stenosis (aortic valve area 0.6 cm(2), mean gradient 60 mmHg). The tumor was in stagnation. She was rejected for surgical valve replacement. We implanted a 29 mm CoreValve aortic prosthesis via transfemoral approach. After the procedure haemodynamic variables remain stable, patient's exertional capacity is excellent.

CONCLUSION: Aortic valve replacement improves survival of cancer patients with symptomatic aortic stenosis. Transcatheter aortic valve replacement (TAVI) is a treatment option in inoperable patients and patients at high surgical risk. Symptoms should not be confused for the progression of the malignant disease. In patient selection emphasis should be made on their frailty and futility. Eligible patients must have a life expectancy of at least 1 year. Final decision has to be made by a multidisciplinary heart team. TAVI can reduce treatment risk and facilitate the oncologic treatment.