JUAN A. CRESTANELLO: Welcome to the Cardiovascular Surgery Series, where we discuss the latest research in cardiovascular surgery from the Mayo Clinic in just 2 minutes. I am Dr. Juan Crestanello, and I am a cardiac surgeon at the Mayo Clinic in Rochester, Minnesota. We will discuss today improved outcomes of valve replacement for carcinoid heart disease.
Carcinoid heart disease occurs in patients with neuroendocrine tumors metastatic to the liver that produce serotonin that leads to fibrosis and scarring of the right-sided heart valves. The tricuspid valve is involved in all cases, while the pulmonary valve is involved in 84% of the patients. The left-side heart valves are involved rarely.
The tricuspid valve and the pulmonary valve are thickened and retracted, leading to tricuspid regurgitation and pulmonary regurgitation, and eventually to right-sided heart failure. In our clinic, we have operated on 240 patients, replacing the valve with bioprosthesis in 84% of the patients.
The recurrence of carcinoid in the bioprosthesis is very rare. The operative mortality in these patients is low and has improved steadily with the use of perioperative somatostatin and with the implementation of a policy of early operation before development of New York Heart Association functional class III or IV symptoms. The long-term survival with surgery is improved compared with medical management.
Most of these patients died from tumor progression rather than from congestive heart failure. We conclude that valve replacement for carcinoid heart disease can be accomplished with acceptable short-term mortality, and early intervention improves overall survival. Thank you for listening to the Mayo Clinic Cardiovascular Surgery Series.
