Malignant Findings in Candidates for Transcatheter Aortic Valve Implantation


  • Hiroshi Kadowaki, MD Mitsui Memorial Hospital, Department of Cardiovascular Medicine, Tokyo, Japan
  • Kazuyuki Yahagi, MD Mitsui Memorial Hospital, Department of Cardiovascular Medicine, Tokyo, Japan
  • Yu Horiuchi, MD Mitsui Memorial Hospital, Department of Cardiovascular Medicine, Tokyo, Japan
  • Kengo Tanabe, MD, PhD Mitsui Memorial Hospital, Department of Cardiovascular Medicine, Tokyo, Japan



metastatic cancer; severe aortic stenosis; non-cardiac findings


Background: In candidates for transcatheter aortic valve implantation (TAVI), preoperative computed tomography (CT) may detect clinically relevant non-cardiac findings. In particular, when malignant findings are detected, patients may be less likely to undergo the procedure. Additionally, they might require further examinations, which may prolong their time to treatment. We investigated how malignant findings affect candidacy for TAVI.

Methods: In this single-center retrospective study, 98 patients with severe aortic stenosis who had undergone preoperative CT between September 2013 and October 2016 were evaluated for malignant findings.

Results: Seven patients (7.1%) had malignant findings. 74 of 91 patients who did not have malignant findings underwent TAVI, SAVR, or balloon aortic valvuloplasty (81.3%). All patients who had malignant findings underwent TAVI or SAVR, and they underwent the procedure sooner after CT than the rest of the patients (mean time to TAVI or SAVR: 24.6 ± 16.8 versus 48.5 ± 45.4 days; P = .003). All 5 patients who had malignant findings without metastatic cancer and who underwent TAVI were still alive during the follow-up period (the mean duration of the follow-up period was 22.3 ± 8.8 months). However, 1 patient who had a malignant finding with metastatic cancer died 7 months after CT.

Conclusion: Our outcomes indicated that the mean duration before TAVI or SAVR was reduced when malignant findings were detected by CT; and TAVI may be a safe and effective treatment for patients with aortic stenosis and a malignant tumor.


Allemani C, Matsuda T, Di Carlo V, et al. 2018. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet 391:1023-75.

Ben-Dor I, Waksman R, Hanna NN, et al. 2010. Utility of radiologic review for noncardiac findings on multislice computed tomography in patients with severe aortic stenosis evaluated for transcatheter aortic valve implantation. Am J Cardiol 105:1461-4.

Goitein O, Di Segni E, Eshet Y, et al. 2015. Non-valvular findings before trans-catheter aortic valve implantation and their impact on the procedure. Isr Med Assoc J 17:764-7.

Gufler H, Schulze CG, Wagner S. 2014. Incidental findings in computed tomographic angiography for planning percutaneous aortic valve replacement: advanced age, increased cancer prevalence? Acta Radiol 55:420-6.

Hara H, Pedersen WR, Ladich E, et al. 2007. Percutaneous balloon aortic valvuloplasty revisited: time for a renaissance? Circulation 115:e334-8.

Hisatomi K, Isomura T, Kawara T, et al. 1989. Changes in lymphocyte subsets, mitogen responsiveness, and interleukin-2 production after cardiac operations. J Thorac Cardiovasc Surg 98:580-91.

Kristensen SD, Knuuti J, Saraste A, et al. 2014. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: the Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J 35:2383-431.

Latsios G, Spyridopoulos TN, Toutouzas K, et al. 2017. Multi-slice CT (MSCT) imaging in pretrans-catheter aortic valve implantation (TAVI) screening. How to perform and how to interpret. Hellenic J Cardiol 59:3-7.

Leon MB, Smith CR, Mack M, et al. 2010. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363:1597-607.

Markewitz A, Faist E, Lang S, Hültner L, Weinhold C, Reichart B. 1996. An imbalance in T-helper cell subsets alters immune response after cardiac surgery. Eur J Cardiothorac Surg 10:61-7.

Merkel S, Eikermann M, Neugebauer EA, von Bandemer S. 2015. The transcatheter aortic valve implementation (TAVI)—a qualitative approach to the implementation and diffusion of a minimally invasive surgical procedure. Eur Heart J Cardiovasc Imaging. 16:731-7.

Minamino-Muta, Kato T, Morimoto T, et al. 2018. Malignant disease as a comorbidity in patients with severe aortic stenosis: clinical presentation, outcomes, and management. Eur Heart J Qual Care Clin Outcomes 4:180-8.

Nishimura RA, Otto CM, Bonow RO, et al. 2014. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of American college of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 63:2438-88.

Okura Y, Ishigaki S, Sakakibara S, et al. 2018. Prognosis of cancer patients with aortic stenosis under optimal cancer therapies and conservative cardiac treatments. Int Heart J 59:750-8.

Onuma Y, Tanabe K, Nakazawa G, et al. 2006. Noncardiac findings in cardiac imaging with multidetector computed tomography. J Am Coll Cardiol 48:402-6.

O'Sullivan CJ, Wenaweser P. 2017. A glimpse into the future: in 2020, which patients will undergo TAVI or SAVR? Interv Cardiol 12:44-50.

Schechter M, Balanescu DV, Donisan T, et al. 2019 An update on the management and outcomes of cancer patients with severe aortic stenosis. Catheter Cardiovasc Interv 94:438-45.

Schultz CJ, Moelker AD, Tzikas A, et al. 2010. Cardiac CT: necessary for precise sizing for transcatheter aortic implantation. Euro Intervention 6 Suppl G:G6-13.

Stachon P, Kaier K, Milde S, et al. 2015. Two-year survival of patients screened for transcatheter aortic valve replacement with potentially malignant incidental findings in initial body computed tomography. Eur Heart J Cardiovasc Imaging 16:731-7.

Vahanian A, Alfieri O, Andreotti F, et al. 2012. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 33:2451-96.

Watanabe Y, Kozuma K, Hioki H, et al. 2016. Comparison of results of transcatheter aortic valve implantation in patients with versus without active cancer. Am J Cardiol 118: 572-7.



How to Cite

Kadowaki, H., Yahagi, K., Horiuchi, Y., & Tanabe, K. (2020). Malignant Findings in Candidates for Transcatheter Aortic Valve Implantation. The Heart Surgery Forum, 23(2), E250-E254.