Early and late outcomes of surgical treatment in carcinoid heart disease

Heidi M. Connolly, Hartzell V Schaff, Martin D. Abel, Joseph Rubin, J. Wells Askew, Zhuo Li, Jacob J. Inda, S. Allen Luis, Rick A. Nishimura, Patricia Pellikka

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background Symptoms and survival of patients with carcinoid syndrome have improved, but development of carcinoid heart disease (CaHD) continues to decrease survival. Objectives This study aimed to analyze patient outcomes after valve surgery for CaHD during a 27-year period at 1 institution to determine early and late outcomes and opportunities for improved patient care. Methods We retrospectively studied the short-term and long-term outcomes of all consecutive patients with CaHD who underwent valve replacement at our institution between 1985 and 2012. Results The records of 195 patients with CaHD were analyzed. Pre-operative New York Heart Association class was III or IV in 125 of 178 patients (70%). All had tricuspid valve replacement (159 bioprostheses, 36 mechanical), and 157 underwent a pulmonary valve operation. Other concomitant operations included mitral valve procedure (11%), aortic valve procedure (9%), patent foramen ovale or atrial septal defect closure (23%), cardiac metastasectomies or biopsy (4%), and simultaneous coronary artery bypass (11%). There were 20 perioperative deaths (10%); after 2000, perioperative mortality was 6%. Survival rates (95% confidence intervals) at 1, 5, and 10 years were 69% (63% to 76%), 35% (28% to 43%), and 24% (18% to 32%), respectively. Overall mortality was associated with older age, cytotoxic chemotherapy, and tobacco use; 75% of survivors had symptomatic improvement at follow-up. Presymptomatic valve operation was not associated with late survival benefit. Conclusions Operative mortality associated with valve replacement surgery for CaHD has decreased. Symptomatic and survival benefit is noted in most patients when CaHD is managed by an experienced multidisciplinary team.

Original languageEnglish (US)
Pages (from-to)2189-2196
Number of pages8
JournalJournal of the American College of Cardiology
Volume66
Issue number20
DOIs
StatePublished - Nov 17 2015

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Carcinoid Heart Disease
Survival
Mortality
Metastasectomy
Bioprosthesis
Patent Foramen Ovale
Pulmonary Valve
Tricuspid Valve
Atrial Heart Septal Defects
Carcinoid Tumor
Tobacco Use
Aortic Valve
Mitral Valve
Coronary Artery Bypass
Survivors
Patient Care
Survival Rate
Confidence Intervals
Biopsy
Drug Therapy

Keywords

  • carcinoid syndrome
  • right-sided heart failure
  • valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Early and late outcomes of surgical treatment in carcinoid heart disease. / Connolly, Heidi M.; Schaff, Hartzell V; Abel, Martin D.; Rubin, Joseph; Askew, J. Wells; Li, Zhuo; Inda, Jacob J.; Luis, S. Allen; Nishimura, Rick A.; Pellikka, Patricia.

In: Journal of the American College of Cardiology, Vol. 66, No. 20, 17.11.2015, p. 2189-2196.

Research output: Contribution to journalArticle

Connolly, Heidi M. ; Schaff, Hartzell V ; Abel, Martin D. ; Rubin, Joseph ; Askew, J. Wells ; Li, Zhuo ; Inda, Jacob J. ; Luis, S. Allen ; Nishimura, Rick A. ; Pellikka, Patricia. / Early and late outcomes of surgical treatment in carcinoid heart disease. In: Journal of the American College of Cardiology. 2015 ; Vol. 66, No. 20. pp. 2189-2196.
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title = "Early and late outcomes of surgical treatment in carcinoid heart disease",
abstract = "Background Symptoms and survival of patients with carcinoid syndrome have improved, but development of carcinoid heart disease (CaHD) continues to decrease survival. Objectives This study aimed to analyze patient outcomes after valve surgery for CaHD during a 27-year period at 1 institution to determine early and late outcomes and opportunities for improved patient care. Methods We retrospectively studied the short-term and long-term outcomes of all consecutive patients with CaHD who underwent valve replacement at our institution between 1985 and 2012. Results The records of 195 patients with CaHD were analyzed. Pre-operative New York Heart Association class was III or IV in 125 of 178 patients (70{\%}). All had tricuspid valve replacement (159 bioprostheses, 36 mechanical), and 157 underwent a pulmonary valve operation. Other concomitant operations included mitral valve procedure (11{\%}), aortic valve procedure (9{\%}), patent foramen ovale or atrial septal defect closure (23{\%}), cardiac metastasectomies or biopsy (4{\%}), and simultaneous coronary artery bypass (11{\%}). There were 20 perioperative deaths (10{\%}); after 2000, perioperative mortality was 6{\%}. Survival rates (95{\%} confidence intervals) at 1, 5, and 10 years were 69{\%} (63{\%} to 76{\%}), 35{\%} (28{\%} to 43{\%}), and 24{\%} (18{\%} to 32{\%}), respectively. Overall mortality was associated with older age, cytotoxic chemotherapy, and tobacco use; 75{\%} of survivors had symptomatic improvement at follow-up. Presymptomatic valve operation was not associated with late survival benefit. Conclusions Operative mortality associated with valve replacement surgery for CaHD has decreased. Symptomatic and survival benefit is noted in most patients when CaHD is managed by an experienced multidisciplinary team.",
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T1 - Early and late outcomes of surgical treatment in carcinoid heart disease

AU - Connolly, Heidi M.

AU - Schaff, Hartzell V

AU - Abel, Martin D.

AU - Rubin, Joseph

AU - Askew, J. Wells

AU - Li, Zhuo

AU - Inda, Jacob J.

AU - Luis, S. Allen

AU - Nishimura, Rick A.

AU - Pellikka, Patricia

PY - 2015/11/17

Y1 - 2015/11/17

N2 - Background Symptoms and survival of patients with carcinoid syndrome have improved, but development of carcinoid heart disease (CaHD) continues to decrease survival. Objectives This study aimed to analyze patient outcomes after valve surgery for CaHD during a 27-year period at 1 institution to determine early and late outcomes and opportunities for improved patient care. Methods We retrospectively studied the short-term and long-term outcomes of all consecutive patients with CaHD who underwent valve replacement at our institution between 1985 and 2012. Results The records of 195 patients with CaHD were analyzed. Pre-operative New York Heart Association class was III or IV in 125 of 178 patients (70%). All had tricuspid valve replacement (159 bioprostheses, 36 mechanical), and 157 underwent a pulmonary valve operation. Other concomitant operations included mitral valve procedure (11%), aortic valve procedure (9%), patent foramen ovale or atrial septal defect closure (23%), cardiac metastasectomies or biopsy (4%), and simultaneous coronary artery bypass (11%). There were 20 perioperative deaths (10%); after 2000, perioperative mortality was 6%. Survival rates (95% confidence intervals) at 1, 5, and 10 years were 69% (63% to 76%), 35% (28% to 43%), and 24% (18% to 32%), respectively. Overall mortality was associated with older age, cytotoxic chemotherapy, and tobacco use; 75% of survivors had symptomatic improvement at follow-up. Presymptomatic valve operation was not associated with late survival benefit. Conclusions Operative mortality associated with valve replacement surgery for CaHD has decreased. Symptomatic and survival benefit is noted in most patients when CaHD is managed by an experienced multidisciplinary team.

AB - Background Symptoms and survival of patients with carcinoid syndrome have improved, but development of carcinoid heart disease (CaHD) continues to decrease survival. Objectives This study aimed to analyze patient outcomes after valve surgery for CaHD during a 27-year period at 1 institution to determine early and late outcomes and opportunities for improved patient care. Methods We retrospectively studied the short-term and long-term outcomes of all consecutive patients with CaHD who underwent valve replacement at our institution between 1985 and 2012. Results The records of 195 patients with CaHD were analyzed. Pre-operative New York Heart Association class was III or IV in 125 of 178 patients (70%). All had tricuspid valve replacement (159 bioprostheses, 36 mechanical), and 157 underwent a pulmonary valve operation. Other concomitant operations included mitral valve procedure (11%), aortic valve procedure (9%), patent foramen ovale or atrial septal defect closure (23%), cardiac metastasectomies or biopsy (4%), and simultaneous coronary artery bypass (11%). There were 20 perioperative deaths (10%); after 2000, perioperative mortality was 6%. Survival rates (95% confidence intervals) at 1, 5, and 10 years were 69% (63% to 76%), 35% (28% to 43%), and 24% (18% to 32%), respectively. Overall mortality was associated with older age, cytotoxic chemotherapy, and tobacco use; 75% of survivors had symptomatic improvement at follow-up. Presymptomatic valve operation was not associated with late survival benefit. Conclusions Operative mortality associated with valve replacement surgery for CaHD has decreased. Symptomatic and survival benefit is noted in most patients when CaHD is managed by an experienced multidisciplinary team.

KW - carcinoid syndrome

KW - right-sided heart failure

KW - valve replacement

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