Improving outcome of valve replacement for carcinoid heart disease

Anita Nguyen, Hartzell V Schaff, Martin D. Abel, S. Allen Luis, Brian D. Lahr, Thorvardur R Halfdanarson, Heidi M. Connolly

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: Carcinoid heart disease is characterized by tricuspid valve regurgitation and varying degrees of pulmonary valve regurgitation or stenosis. Valve replacement procedures may be complicated by systemic effects of carcinoid syndrome, as well as hepatic dysfunction and right heart failure. This study was performed to identify factors that might be associated with improving early mortality rates and late outcomes. Methods: Between November 1985 and January 2018, 240 adult patients underwent surgery for carcinoid heart disease at the Mayo Clinic. We analyzed the association of multiple clinical and echocardiographic variables on early mortality and late survival. Results: The median (interquartile range) age of patients was 63 years (55-69), and 117 patients (49%) were male. Before operation, 157 patients (70%) had New York Heart Association class III or IV limitation. Somatostatin analogs were used in 221 patients (92%), and long-acting somatostatins were used in 130 patients (54%). Loop diuretic therapy was used preoperatively in 125 patients (52%). Early mortality rate was 29% (9/22) between 1985 and 1994, but decreased to 7% (6/81) during 1995 to 2004, and to 5% (7/128) from 2005 onward. Overall survival estimates at 1, 3, and 5 years were 69%, 48%, and 34%, respectively. Older age, advanced New York Heart Association class, and a nonlinear effect of creatinine were independently associated with overall mortality. Conclusions: Valve replacement for carcinoid heart disease has acceptable short-term mortality, and early risk has decreased in the current era. Earlier intervention may improve overall survival.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Carcinoid Heart Disease
Mortality
Somatostatin
Survival
Pulmonary Valve Insufficiency
Sodium Potassium Chloride Symporter Inhibitors
Tricuspid Valve Insufficiency
Pulmonary Valve Stenosis
Carcinoid Tumor
Creatinine
Heart Failure

Keywords

  • carcinoid heart disease
  • surgery
  • tricuspid valve

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Improving outcome of valve replacement for carcinoid heart disease. / Nguyen, Anita; Schaff, Hartzell V; Abel, Martin D.; Luis, S. Allen; Lahr, Brian D.; Halfdanarson, Thorvardur R; Connolly, Heidi M.

In: Journal of Thoracic and Cardiovascular Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Nguyen, Anita ; Schaff, Hartzell V ; Abel, Martin D. ; Luis, S. Allen ; Lahr, Brian D. ; Halfdanarson, Thorvardur R ; Connolly, Heidi M. / Improving outcome of valve replacement for carcinoid heart disease. In: Journal of Thoracic and Cardiovascular Surgery. 2018.
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AB - Objective: Carcinoid heart disease is characterized by tricuspid valve regurgitation and varying degrees of pulmonary valve regurgitation or stenosis. Valve replacement procedures may be complicated by systemic effects of carcinoid syndrome, as well as hepatic dysfunction and right heart failure. This study was performed to identify factors that might be associated with improving early mortality rates and late outcomes. Methods: Between November 1985 and January 2018, 240 adult patients underwent surgery for carcinoid heart disease at the Mayo Clinic. We analyzed the association of multiple clinical and echocardiographic variables on early mortality and late survival. Results: The median (interquartile range) age of patients was 63 years (55-69), and 117 patients (49%) were male. Before operation, 157 patients (70%) had New York Heart Association class III or IV limitation. Somatostatin analogs were used in 221 patients (92%), and long-acting somatostatins were used in 130 patients (54%). Loop diuretic therapy was used preoperatively in 125 patients (52%). Early mortality rate was 29% (9/22) between 1985 and 1994, but decreased to 7% (6/81) during 1995 to 2004, and to 5% (7/128) from 2005 onward. Overall survival estimates at 1, 3, and 5 years were 69%, 48%, and 34%, respectively. Older age, advanced New York Heart Association class, and a nonlinear effect of creatinine were independently associated with overall mortality. Conclusions: Valve replacement for carcinoid heart disease has acceptable short-term mortality, and early risk has decreased in the current era. Earlier intervention may improve overall survival.

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