Carcinoid heart disease: outcomes after surgical valve replacement

Abstract

Objectives: To describe the early and late outcomes of carcinoid patients undergoing surgical heart valve replacement.

Methods: In a retrospective study, records of patients with symptomatic carcinoid heart disease referred for valve surgery between 1993 and 2010 at two academic centres were reviewed. The perioperative and postoperative outcomes were analysed.

Results: Nineteen patients, with a mean age of 56 ± 9.6 years, underwent cardiac surgery for carcinoid syndrome. Sixteen patients underwent implantation of one or more mechanical bileaflet valve prosthesis and three patients had one or more bioprosthetic valves implanted. Survival after 1 and 5 years was 71 and 43%, respectively. Six out of nine survivors were at last follow-up in New York Heart Association class I. Valve-related events such as valve thrombosis or bleeding complications were not registered. Echocardiography showed improvement of right ventricular dilatation in 80% of patients.

Conclusions: Despite advanced cardiac morbidity at the time of operation, early postoperative survival was 90%. Long-term survival of patients with carcinoid heart disease undergoing valve replacement is determined by carcinoid progression. The surviving patients had a persistent improvement in functional capacity without valve-related complications of the mechanical prosthesis.