Aortic stenosis is caused by a buildup of calcium deposits in the heart valve. Excessive buildup can cause narrowing of the heart valve, a decrease in blood pressure, and can lead to heart failure (Lopez-Jimenez, M.D., 2021). The most effective treatment for this disease is surgical valve replacement. However, this procedure poses great risk to a patient with active cancer in the area. The complications that could incur from undergoing this procedure would likely lead to infections and excessive bleeding (Bendary, et. al., 2020). Other treatments, such as angiotensin-converting enzyme inhibitors and beta blockers, have been used but patients typically die within a few years because the treatments are too conservative (Kornowski, Landes 2018). The aortic valve replacement procedure is intrusive, exposing the cancer patient to high-risk complications, on the other hand, medications have been found to be not aggressive enough, leading to death of the patient.
An alternative treatment method has been tested, called TAVR. This is a transcatheter aortic valve replacement treatment, which is less intrusive than an open-heart valve replacement (Henry Ford Health System Staff, 2019). A cancer patient would be an ideal person to receive this type of treatment because of reduced intrusiveness of the procedure. The use of this treatment on cancer patients has yet to be deemed safe and reliable (Marmagkiolis et. al., 2021). After surgery, cancer patients undergoing this type of treatment have been found to have a worse 1-year prognosis when compared to their non-cancer counterparts (Landes, 2019) A study published by the Journal of the American College of Cardiology states that cancer patients have a decreased long-term life expectancy compared to their non-cancer counterparts after undergoing this procedure (Lind, et. al., 2020). Without understanding the effectiveness, safety, and reliability of this treatment, is it ethical for cancer patients to have this procedure? Is there enough evidence supporting the long-term benefits of this procedure to allow cancer patients to face potential risks?
References:
Bendary, A., Ramzy, A., Bendary, M., & Salem, M. (2020, March 11). Transcatheter aortic valve replacement in patients with severe aortic stenosis and active cancer: A systematic review and meta-analysis. US National Library of Medicine National Institutes of Health . Retrieved November 29, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7066604/.
Henry Ford Health System Staff. (2019, August 26). Less invasive aortic valve procedure approved for low-risk patients. Henry Ford LiveWell. Retrieved November 29, 2021, from https://www.henryford.com/blog/2019/08/less-invasive-aortic-valve-procedure-approved-low-risk-patients.
Kornowski, R., & Landes, U. (2018, April 20). The double jeopardy of aortic stenosis in cancer patients . Academic.oup.com. Retrieved November 29, 2021, from https://academic.oup.com/ehjqcco/article/4/3/150/4979550.
Landes, U., Iakobishvili, Z., & Vronsky, D. (2019, January 9). TAVR in cancer patients with severe AS. American College of Cardiology. Retrieved November 29, 2021, from https://www.acc.org/latest-in-cardiology/journal-scans/2019/01/09/14/19/transcatheter-aortic-valve-replacement-in-oncology-patients.
Lind, A., Totzeck, M., Mahabadi, A. A., Jánosi, R. A., Gabry, M. E., Ruhparwar, A., Mrotzek, S. M., Hinrichs, L., Akdeniz, M., Rassaf, T., Mincu, R. I., C.E., D. S., Al., E., D., C., G.C., J., M., T., C., F., S.H., A., W.K., H., … B.R., L. (2020, December 2). Impact of cancer in patients undergoing transcatheter aortic valve replacement: A Single-Center Study. JACC. Retrieved November 29, 2021, from https://www.jacc.org/doi/10.1016/j.jaccao.2020.11.008.
Lopez-Jimenez, F. (2021, February 19). Aortic calcification: an early sign of heart valve problems?Mayo Clinic. Retrieved November 29, 2021, from https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/expert-answers/aortic-valve-calcification/faq-20058525.
Marmagkiolis, K., Monlezun, D. J., Cilingiroglu, M., Grines, C., Herrmann, J., Toutouzas, K. P., Ates, I., & Iliescu, C. (2021, August 4). TAVR in cancer patients: Comprehensive review, meta-analysis, and meta-regression. Frontiers in Cardiovascular Medicine. Retrieved November 29, 2021, from https://www.frontiersin.org/articles/10.3389/fcvm.2021.641268/full.
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