Quadruple Valve Replacement for Carcinoid Heart Disease

Area of Science:

• Cardiology
• Cardiac Surgery
• Oncology

Background:

• Carcinoid heart disease (CHD) typically affects right-sided heart valves (tricuspid, pulmonary) due to serotonin metabolism in the lungs, leading to right heart failure.
• Left-sided valve involvement in CHD is rare, making cases with all four valves affected exceptionally uncommon, with only four prior reports.
• This study addresses the surgical management of a rare presentation of CHD involving all four cardiac valves.

Purpose of the Study:

• To describe the surgical experience and outcomes of patients with carcinoid heart disease affecting all four cardiac valves.
• To evaluate the feasibility, safety, and medium-term efficacy of quadruple valve replacement in this rare patient cohort.

Main Methods:

• Three patients with carcinoid heart disease underwent simultaneous quadruple valve replacement and right ventricular outflow tract reconstruction.
• Preoperative management included intravenous octreotide for 24 hours, continued postoperatively in the intensive care unit.
• Surgical procedures involved cardiopulmonary bypass with detailed cross-clamp and bypass time recordings.

Main Results:

• All three patients successfully underwent quadruple valve replacement with excellent medium-term outcomes (NYHA class 1 at 6-16 months follow-up).
• Surgical times averaged 175 minutes for cross-clamp and 210 minutes for bypass, with short intensive care unit and inpatient stays.
• No major postoperative complications were reported, including no requirement for permanent pacemakers, and echocardiography confirmed well-functioning prostheses without paravalvular leaks.

Conclusions:

• Quadruple valve replacement is a viable and safe surgical option for carcinoid heart disease involving all four valves.
• Excellent medium-term survival and quality of life can be achieved, supporting consideration for surgery in all CHD patients irrespective of valvular extent.