Table 3.

Studies on TAVR and/or SAVR outcomes in postradiation therapy patients

Year	Authors	Study design	Study population (N)	Follow-up	Outcome
Sep 2021	Yazdchi et al48	Retrospective, single-center	TAVR (69) vs SAVR (117) in patients with a history of AS and chest-directed radiation therapy	37 mo (median)	TAVR was associated with better expected mortality compared to intermediate-/high-risk SAVR patients and similar outcomes compared to low-risk SAVR patients; TAVR patients had shorter ICU time, length of stay, and required less postoperative blood transfusions
April 2021	Kherallah et al49	Retrospective, single-center	TAVR patients (N = 1341) of whom a subset49 had prior chest radiation therapy	24 mo (median)	TAVR patients with a prior history of chest radiation had significant increased rates of postprocedural respiratory failure and need for a permanent, but no difference in overall mortality, 30-d mortality, 30-d readmission rate compared to patients without a prior history of chest radiation
Feb 2021	Nauffal et al50	Retrospective, multi-center (Society of Thoracic Surgeons’ database)	TAVR (1668) vs SAVR (2611) in patients with severe symptomatic AS and a prior history of mediastinal radiation	Database from 2011 to 2018 and studied 30-d outcomes	TAVR was associated with significantly ↓ 30-d mortality and postoperative complications compared to SAVR
2020	Elbadawi et al51	Retrospective, multi-center (National Inpatient Sample Database)	TAVR (2170) vs SAVR (1505) in patients with severe AS and prior mediastinal radiation	Database from 2012 to 2017 and studied in-hospital mortality	TAVR compared to SAVR was associated with lower in-hospital mortality as well as decreased rates of acute kidney injury, use of mechanical circulatory support, bleeding and respiratory complications, and shorter length of hospital stay, but higher rates of pacemaker insertion
2020	Zafar et al52	Systemic review and meta-analysis (Dijos et al, Bouleti et al, Agrawal et al, and Gajanana et al, see below)	TAVR outcomes in patients with severe AS with a history of chest radiation therapy (164) vs. those with severe AS without a history of chest radiation therapy (1846)	1 y	TAVR produced similar short-term all-cause mortality, safety and efficacy in patients with prior radiation vs. those without, but 1-y all-cause mortality and postprocedural heart failure exacerbation increased in group with prior radiation
2019	Agrawal et al53	Observational cohort	TAVR in patients with symptomatic severe AS (610) comparing a subset with a prior history of chest radiation therapy (75) to the remainder of the cohort	17.1 mo (mean)	TAVR patients with prior radiation therapy had a significantly higher incidence of all-cause mortality (nearly 2-fold increase in mortality) and major adverse cardiovascular event
2019	Gajanana et al54	Single-center, prospective	TAVR in patients with a history of prior chest radiation44 compared to those without a prior history of chest radiation (1106)	1 y	No significant difference in 30-d or 1-y mortality in TAVR patients with vs. without prior radiation therapy
2019	Zhang et al55	Single-center, retrospective	TAVR54 vs. SAVR54 in patients with severe AS with a history of mediastinal radiation	1 y	TAVR patients with native severe AS and prior chest radiation had a shorter hospital stay and decreased incidence of postprocedural atrial fibrillation, as well as lower adjusted 30-d and 1-y all-cause mortality
2016	Bouleti et al56	Single-center, prospective	TAVR in patients with symptomatic severe AS (288) comparing a subset with a prior history of chest radiation26 to matched controls	5-y	TAVR patients with a prior history of radiation experienced improved functional status after TAVR and comparable mortality rates as those without; the most common cause of death was respiratory failure in the group postradiation therapy
2015	Dijos et al57	Single-center, prospective	TAVR in patients with severe symptomatic AS divided into radiation-induced valvular disease cases19 and suspected degenerative cases (179)	6 mo	TAVR patients with radiation-induced valvular heart disease did not have a significantly different 30-d mortality from the degenerative valvular disease group and had a comparably lower mortality at 6-mo follow-up

AS, aortic stenosis; SAVR, surgical aortic valve replacement; TAVR, transcatheter aortic valve replacement.