Acute and Midterm Outcomes of Patients Undergoing Right-Sided Heart Valve Surgery for Carcinoid Heart Valve Disease

Background: Carcinoid heart disease (CaHD) is a rare manifestation of metastatic neuroendocrine tumor (NET) causing right valvular dysfunction and subsequent symptomatic right heart failure with reduced long-term survival. However, limited data exist regarding outcomes of right-sided heart valve surgery in such patients. The aim of this study was to analyze outcomes of valve surgery in patients with CaHD.

Method: Between June 2011 and April 2022, twelve patients (75% male; mean age: 62.0 ± 12.4 years, STS score: 2.5 ± 1.6%) with symptomatic right heart failure and CaHD underwent elective valve surgery at our institution and were retrospectively included in our study. Procedural data, early clinical outcomes, survival, and time of reintervention were analyzed.

Results: All patients received tricuspid biological valve replacement (TVR) and four patients received concomitant pulmonary valve replacement (PVR). Surgical approach was 3D-endoscopic via right anterolateral minithoracotomy in 33.3% (4/12) and median sternotomy in 66.7% (8/12) of cases. Surgery was performed in beating heart-technique in 58.3% (7/12) of patients. Rethoracotomy due to postoperative bleeding was necessary in two patients (16.7%) and acute kidney injury occurred in one patient. No permanent pacemaker implantation and no stroke occurred in the study group. Postprocedure echocardiography showed competent TVR and PVR in all cases. Overall 30-day mortality was 8.3% (1/12) due to acute hepatic failure in one patient. During follow-up, two patients died after 19 months and 131 months due to progression of NET and right ventricular failure. As a consequence to progression of NET, five patients received reintervention for degeneration of the implanted heart valve in a period between 11 and 44 months. Two patients underwent redo surgery (one re-TVR, one re-PVR). One patient initially underwent pulmonary balloon valvuloplasty followed by two valve-in-valve intervention (VIV) with balloon-expandable transcatheter heart valve (BE-THV). Two other patients received a VIV procedure for pulmonary and tricuspid valve with BE-THV.

Conclusion: Our single-center results give insights in treatment options of a rare cardiovascular disease. Treatment of CaHD is technically feasible with acceptable early clinical and hemodynamic outcomes. However, treatment strategies involve reinterventions in several patients depending on NET progression. Therefore, a multidisciplinary team for adequate treatment of this seldom patient cohort is mandatory.

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Artikel online veröffentlicht:
28. Januar 2023