Endocrine Abstracts

Aim To describe the early 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 2012 and 2021 were reviewed. The perioperative and early postoperative outcomes were analyzed.

Results Thirteen patients, with a mean age of 64 years (range 55-79 years) underwent cardiac surgery for carcinoid syndrome. 3 patients had quadruple valve replacement, 7 had tricuspid and pulmonary valves changed, 2 had tricuspid valve replacement, while one had tricuspid, pulmonary, and aortic valves replaced. Right-sided valves were replaced with biological valves in 12 patients and a mechanical valve in 1 patient. Left-sided valves were replaced with a mechanical valve in 2 patients and with a biological valve in 1 patient. Mean postoperative follow-up was 56 months (range 2-102 months, median 65 months). All patients had a good left ventricle except one, in whom it was mildly impaired. The right ventricle was severely dilated in 4 patients, moderately in 4, and mildly in 3. One patient died of heart failure 10 days postoperatively and one patient succumbed to Acute Carcinoid Crisis 8 days after surgery. Functional improvement was noted in all survivors, and they were all in New York Heart Association class I-2 at last follow up and none required permanent pacemaker. One patient capitulated to neuro-endocrine tumour at nearly 6 years, giving us survival rate of 91% at 56 months (range 2-102 months). Nobody required any valve intervention in the follow-up period.

Conclusion Although carcinoid syndrome is a rare and progressive disease, valve replacement in symptomatic patients is a reasonable option with survival benefit, low early postoperative mortality, without valve-related complications, and with functional improvement. Cardiac assessment is required in all patients with carcinoid disease to ensure that appropriate patients are put forward for surgery when symptomatic.