Thoracic radiation therapy exposes to aortic stenosis and surgery is associated with high orbid-mortality rates. Trans-catheter aortic valve implantation (TAVI) may represent an interesting alternative, but experience remains limited in this setting. We compared late outcome in a Radiation group and a matched population undergoing TAVI and identified predictive factors of late survival.

Between October 2006 and April 2011, 288 consecutive patients underwent TAVI in our institution, of whom 27 had previous chest radiation. They were matched 1:1 on age, sex and TAVI approach with a control population.

Mean age was 72±13 years in the Radiation group versus 75±9 in the control group (p=0.52), 48% were male and 15% had a trans-apical approach. Procedural success was 89% (n=24) in the Radiation group versus 96% (n=26) in controls and 30-day survival was 93±5% in both groups. Follow-up was complete in all patients (median 3.4; interquartile range [2.6– 4.2] years). Five-years survival rates were 32±10% in the Radiation group and 41±11% in controls (p=0.27). In Radiation group, the cause of death was respiratory failure secondary to radiation-induced fibrosis or sepsis in 54% of cases. In multivariate analysis, we identified 3 predictive factors of late death in Radiation group: 1 pre-procedural variable: the absence of Beta-blockers therapy (HR=36.3 [4.1–325.2], p=0.001), and 2 post-procedural variables: creatinine peak (HR=1.04 [1.02-1.07], p<0.0001) and infectious complication (HR=7.8 [1.7-36.0], p=0.009). In the radiation group, 89% of survivors were in NYHA class I-II at last follow-up.

Patients of the Radiation group displayed high mortality rates even though not significantly different from the control population. In patients with radiation valvular disease, the use of B-blockers was an independent predictor of late survival after TAVI which deserves further consideration. Moreover, respiratory failure was the main cause of death, emphasizing the need for a careful pulmonary evaluation. Finally, we show a sustained improvement in functional results after TAVI in this particular population.