Bioprosthetic valve monitoring in patients with carcinoid heart disease

Abstract

BackgroundCarcinoid heart disease (CnHD) is a frequent cause of morbidity and mortality in patients with neuroendocrine tumors and carcinoid syndrome. Although valve replacement surgery appears to decrease all-cause mortality in patients with advanced CnHD, few studies have investigated the outcomes of patients after valve replacement.MethodsWe conducted a multi-institution retrospective registry of patients who received both tricuspid and pulmonic bioprosthetic valve (TV/PV) replacements for advanced CnHD from November 2005 to March 2021. Patients were followed post-operatively with echocardiographic studies every 3 months. Carcinoid valvular heart disease scores were used to monitor valve degeneration. Neuroendocrine tumor treatment, their administration times, and associations with echocardiographic findings were recorded.ResultsOf 87 patients with CnHD, 22 patients underwent simultaneous surgical TV and PV replacement. In 6 patients (27.3%), increased PV Vmax was the first echocardiographic manifestation of valve degeneration in the setting of occult neurohormonal release. Post-operative telotristat ethyl and peptide receptor radionuclide therapy appeared to stabilize PV Vmax. The PV Vmax showed consistent elevation in the entire patient population when compared to baseline, while bioprosthetic TV echocardiographic parameters were relatively unchanged throughout. Post-operative warfarin therapy did not affect the rate of PV degeneration, and no major bleeding was recorded during or after post-operative anticoagulation therapy.ConclusionBioprosthetic valve degeneration is common in CnHD. Monitoring with echocardiographic studies every 3 months, focusing on PV velocities, could identify patients with occult disease that very likely promotes valve degeneration. Novel neuroendocrine tumor therapies may have a beneficial impact on valve degeneration.

Hedinger Syndrome—Lessons Learnt: A Single-Center Experience

“…Overall mortality during the study interval was 72.7% (8/11). Our results are comparable to the groups of Collony, Yong, Honan, and others [7,13,[22][23][24]. The overall postoperative survival at 1, 3, and 5 years was reported as 69%, 48%, and 34%, based on a Mayo Clinic series evaluating 240 patients [7,24].…”

“…During the present follow up, the recurrence of tricuspid valve disease was naturally more likely in repaired than in replaced patients. This is consistent with other studies and the European Neuroendocrine Tumor Society's (ENETS) 2022 guidance [7,23]. Consequently, we changed our strategy and adapted as the treatment of choice the bio-prosthesis valve-in native valve implantation (TVI) technique with the preservation of the valvular apparatus for the pulmonary and tricuspid valve lesions.…”

“…Another serious postoperative complication might be the recurrence of valvular heart disease or structural valve deterioration [23]. Two of our patients showed significant postoperative valve or prosthesis degeneration and required re-intervention during the late postoperative period.…”

Case Report: Carcinoid heart disease with severe tricuspid regurgitation and concomitant patent foramen ovale causing severe hypoxia

“…Low operative numbers (TVR and PVR are relatively uncommon in adult cardiothoracic surgical practice) result in limited information regarding surgical technical aspects and valve replacement optimisation ( 3 ). Lastly, it is recognised that the implantation of bioprosthetic material in the context of active carcinoid is commonly associated with valve degeneration, particularly pulmonic implants ( 9 ).…”

“…Low operative numbers (TVR and PVR are relatively uncommon in adult cardiothoracic surgical practice) result in limited information regarding surgical technical aspects and valve replacement optimisation (3). Lastly, it is recognised that the implantation of bioprosthetic material in the context of active carcinoid is commonly associated with valve degeneration, particularly pulmonic implants (9). PFO closure in isolation has been shown to benefit patients with carcinoid syndrome without valvular disease at 6 months regarding systemic arterial oxygenation, 6 m walk test, and New York Heart Association score (10).…”