Impact of Cancer in Patients Undergoing Mitral Transcatheter Edge-To-Edge Repair: A Singe-Center Study

Background

The number of Mitral Transcatheter Edge-To-Edge Repair (M-TEER) is increasing. Cancer survivors and patients with active cancer (AC) represent a special higher-risk cohort, necessitating adjustment of indications and risk assessment prior to M-TEER.

The purpose of this study was to determine the impact of active and stable cancer on peri-procedural complications and short- and long-term survival in a real-world, single-center cohort of patients treated with M-TEER. Specifically, we aimed to assess the risk for this particular patient population. 

Methods

Consecutive patients treated with M-TEER at the University Hospital Essen, Department of Cardiology and Angiology between 2019 and 2024 were grouped as follows: Controls (patients without cancer), stable cancer (SC), and active cancer (AC). AC being defined as cancer diagnosis or cancer-related therapy within the past 6 months, active metastatic disease or active cancer recurrence. Cancer patients were treated both at the West German Tumor Center (WTZ) in Essen and externally.

Primary endpoints were peri-procedural complications and 30-day survival. A secondary endpoint was the long-term mortality of up to 5 years with stratification into subgroups (cardiovascular-related, cancer-related). Categorical data were compared between groups using χ2 or Fisher's exact test. Continuous variables were compared using the student's t-test if normally distributed or the Mann-Whitney U test if not.

Results

A total of 400 patients treated with M-TEER were selected: 293 controls (73.25%), 71 SC (17.75%), and 36 AC (9%). All three groups were similar in age (77.25 ± 10.47 for the controls, 77.42 ± 9.05 for SC, 77.14 ± 7.7 for AC). Most patients had mitral regurgitation (MR) classified as MR IV° (controls: 77.6% vs. SC: 80.3%, p = 0.99; controls vs. AC: 77.8%, p = 0.98), while the remainder had MR III°. Other baseline characteristics did not differ between the study groups with respect to sex, New York Heart Association (NYHA) class, Society for Thoracic Surgeons (STS) score, atrial fibrillation, hypertension, diabetes mellitus, as well as laboratory and echocardiographic parameters.

Predominant malignancies were breast carcinoma (28.03%), prostate carcinoma (20.6%), skin cancer (malignant melanoma and basal cell carcinoma, 16.82%), and hematological malignancies (multiple myeloma, B-cell lymphoma, Hodgkin and Non-Hodgkin lymphoma, 15.9%). The previous cancer treatment consisted of surgery (n = 75), radiotherapy (n = 38) and chemotherapy (n = 30). There were no significant differences concerning cancer therapy between AC and SC patients.

In the majority of cases, only one PASCAL device was implanted (n = 283), especially in patients with AC (n = 33). Previous MR III-IV° was reduced to mild to moderate MR in the majority of cases, with no significant differences between controls and SC patients (p = 0.55) or between controls and AC patients (p = 0.52).

No differences in survival were observed between controls and SC patients, or between controls and patients with active cancer, both at 30 days and up to 5 years (p = 0.8).

Conclusions 

Our data show that M-TEER is a safe treatment option for cancer patients. M-TEER could be performed in cancer patients when indicated, considering that cancer patients have similar periprocedural complications and short-term survival compared to control patients. However, future studies are needed to confirm these findings in different cohorts.