Transcatheter Aortic Valve Replacement Facilitates Anti‐Cancer Therapy Continuity and Improves Survival in Cancer Patients

BACKGROUND: The impact of transcatheter (TAVR) versus surgical aortic valve replacement (SAVR) on multi-dimensional anti‑cancer therapy continuity and survival in cancer patients with severe aortic stenosis (AS) remains unknown. AIMS: To assess whether TAVR, compared with SAVR, is associated with superior anti-cancer therapy continuity and survival in cancer patients with severe AS. METHODS: We conducted a retrospective study of cancer patients undergoing TAVR or SAVR for severe AS from June 2018 to December 2024. Inverse probability of treatment weighting (IPTW) was used. Endpoints included 90‑day therapy resumption (primary; Fine-Gray competing risk regression), 1‑year completion, cardiac‑related interruptions, and mortality. Sensitivity, landmark, and dose-response analyses were performed. RESULTS: Among 183 patients (TAVR: 101, SAVR: 82), IPTW achieved excellent balance. TAVR was associated with higher 90‑day resumption (83.7% vs. 56.3%; OR 3.51, p < 0.001) and shorter time to resumption (28 vs. 75 days; sHR 2.45, p < 0.001). A dose-response relationship was observed: each 30‑day delay increased cancer mortality by 15% (HR 1.15, p = 0.01). TAVR reduced non‑fatal cardiac‑related interruptions (6.9% vs. 17.1%; OR 0.28, p = 0.01). Therapy interruption independently predicted all‑cause mortality (HR 1.48, p = 0.001), even after excluding progression‑related interruptions (sensitivity HR 1.32, p = 0.02). Landmark analysis at 3 months showed better subsequent survival with early resumption (HR 0.61, p = 0.01). Benefits were most pronounced in neoadjuvant patients (interaction p = 0.04). Competing risk analysis showed lower 3‑year cardiovascular mortality with TAVR (4% vs. 12%; p = 0.04). CONCLUSIONS: TAVR was associated with superior therapy continuity and fewer cardiac interruptions. A dose‑dependent association between treatment delay and cancer mortality was observed. These findings suggest that TAVR may be preferred in patients requiring timely neoadjuvant therapy, but prospective validation is needed.