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A 33-year follow-up after valvular surgery for carcinoid heart disease

Johannes Bergsten1,2, Frank A Flachskampf1,2, Lennart Lundin1,2

  • 1Department of Clinical Physiology and Cardiology, University Hospital, Uppsala, Sweden.

European Heart Journal. Cardiovascular Imaging
|April 26, 2021
PubMed

Insights

Valvular surgery for carcinoid heart disease (CaHD) improves survival, especially with combined tricuspid and pulmonary valve replacement. Biomarkers like NT-pro-BNP and 5-HIAA predict poor outcomes in CaHD patients.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Oncology

Background:

  • Carcinoid heart disease (CaHD) involves valvular damage, primarily affecting the tricuspid and pulmonary valves.
  • Surgical intervention for severe CaHD has improved long-term prognosis, but data on survival predictors and optimal surgical strategy remain limited.

Purpose of the Study:

  • To review survival and echocardiographic findings in patients who underwent valvular surgery for severe CaHD.
  • To identify predictors of survival and evaluate the strategy of single versus double-valve surgery in CaHD.

Main Methods:

  • Retrospective review of 60 consecutive patients with severe CaHD undergoing valve surgery between 1986 and 2019.
  • Analysis included preoperative echocardiography, creatinine, NT-pro-brain natriuretic peptide (NT-pro-BNP), and 24-h urinary 5-hydroxyindoleacetic acid (5-HIAA).
  • Surgical procedures were categorized into combined tricuspid valve replacement (TVR) and pulmonary valve replacement (PVR) versus TVR-only or TVR with pulmonary valvotomy.

Main Results:

  • 30-day mortality was 12%, decreasing to 8% in the most recent decade (2010-2019). Median survival was 2.2 years.
  • Combined TVR and PVR demonstrated significantly higher survival rates (median 3.0 years) compared to operations without PVR (median 0.9 years).
  • Elevated preoperative NT-pro-BNP and 5-HIAA levels in the top quartile were associated with poor survival. Preoperative echocardiography sometimes underestimated pulmonary valve pathology.

Conclusions:

  • Valvular surgery for CaHD is associated with acceptable perioperative risk.
  • Combined TVR and PVR should be considered for most CaHD patients due to improved survival outcomes.
  • Bioprosthetic valves show adequate durability relative to the oncological life expectancy of CaHD patients.
Abstract

Keywords:
carcinoid heart diseaseechocardiographyvalve replacementvalvular heart disease

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