Optimized Outcomes Using a Standardized Approach for Treatment of Patients with Carcinoid Heart Disease

TY - JOUR

T1 - Optimized Outcomes Using a Standardized Approach for Treatment of Patients with Carcinoid Heart Disease

AU - Silaschi, Miriam

AU - Barr, James

AU - Chaubey, Sanjay

AU - Nicou, Niki

AU - Srirajaskanthan, Raj

AU - Byrne, Jonathan

AU - Ramage, John

AU - MacCarthy, Philip

AU - Wendler, Olaf

N1 - © 2016 S. Karger AG, Basel.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - BACKGROUND: Carcinoid heart disease (CHD) is common in patients with carcinoid syndrome (CS). Surgical treatment improves the poor prognosis of CHD, although the reported perioperative mortality is high (∼17%). We attempted to improve outcomes by implementation of a protocol for the management of patients with CHD at a UK Neuroendocrine Centre of Excellence and report our experience.METHODS: All patients treated for CHD between 2008 and 2015 were included. Peri-operative treatment included surgical features such as invasive pulmonary valve (PV) inspection and preservation of the tricuspid subvalvular apparatus.RESULTS: A total of 11 patients were treated, median age was 63 years (IQR: 56-70). In 10 patients both pulmonary (PVR) and tricuspid valve (TVR) were replaced, one patient underwent isolated TVR. One patient had additional aortic valve replacement (AVR), another one coronary artery bypass grafting. Bioprostheses (BP) were used in all patients, stented for TVR and AVR, stentless for PVR. Invasive PV inspection caused unplanned PVR in three cases (27.3%). All patients were discharged home. One patient (9.1%), who had previous TVR by another surgeon, had right heart failure (RHF) during follow-up. One death occurred due to progression of CS (day 346). The carcinoids' primary was resected in five patients (45.5%) 10 months (4.5-19.5) after cardiac surgery.CONCLUSION: Excellent results were achieved in patients with CHD. PV stenosis can be underestimated by echocardiography, therefore intraoperative inspection is recommended. Right ventricular geometry should be respected to prevent RHF. BP should be used, as these patients are likely to undergo future non-cardiac surgeries.

AB - BACKGROUND: Carcinoid heart disease (CHD) is common in patients with carcinoid syndrome (CS). Surgical treatment improves the poor prognosis of CHD, although the reported perioperative mortality is high (∼17%). We attempted to improve outcomes by implementation of a protocol for the management of patients with CHD at a UK Neuroendocrine Centre of Excellence and report our experience.METHODS: All patients treated for CHD between 2008 and 2015 were included. Peri-operative treatment included surgical features such as invasive pulmonary valve (PV) inspection and preservation of the tricuspid subvalvular apparatus.RESULTS: A total of 11 patients were treated, median age was 63 years (IQR: 56-70). In 10 patients both pulmonary (PVR) and tricuspid valve (TVR) were replaced, one patient underwent isolated TVR. One patient had additional aortic valve replacement (AVR), another one coronary artery bypass grafting. Bioprostheses (BP) were used in all patients, stented for TVR and AVR, stentless for PVR. Invasive PV inspection caused unplanned PVR in three cases (27.3%). All patients were discharged home. One patient (9.1%), who had previous TVR by another surgeon, had right heart failure (RHF) during follow-up. One death occurred due to progression of CS (day 346). The carcinoids' primary was resected in five patients (45.5%) 10 months (4.5-19.5) after cardiac surgery.CONCLUSION: Excellent results were achieved in patients with CHD. PV stenosis can be underestimated by echocardiography, therefore intraoperative inspection is recommended. Right ventricular geometry should be respected to prevent RHF. BP should be used, as these patients are likely to undergo future non-cardiac surgeries.

U2 - 10.1159/000446213

DO - 10.1159/000446213

M3 - Article

C2 - 27097025

SN - 0028-3835

VL - 104

SP - 257

EP - 263

JO - Neuroendocrinology

JF - Neuroendocrinology

IS - 3

ER -