Cardiac surgery for carcinoid heart disease in 12 cases

Komoda, Satsuki; Komoda, Takeshi; Pavel, Marianne; Morawietz, Lars; Wiedenmann, Bertram; Hetzer, Roland; Lehmkuhl, H.

doi:10.1007/s11748-010-0758-9

Cited by 19 publications

(15 citation statements)

References 23 publications

(22 reference statements)

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“…This reflects early referral and is emphasized by the observation that most patients had a normal pre-operative right ventricular function. This is in contrast to other experiences published, which report a three times higher incidence of RHF (66.6%) prior to cardiac surgery [7] or a larger number of patients suffering from severe heart failure (50% NYHA class III-IV prior to the procedure) [6] . Although our patients did not have advanced RHF, most of them were inoperable for tumour resection, as only 18.2% had received resection of the neuroendocrine tumour beforehand.…”

Section: Baseline Characteristics Of Patients With Chdcontrasting

confidence: 88%

“…Adverse haemodynamic effects due to PPM in the low-pressure system are more severe than found after left-sided heart valve surgery. In comparison to a series of 12 patients in whom PVR was performed using stented BP, with a perioperative mortality of 16.7%, we did not observe any fatalities due to RHF [7] . Unfortunately, the authors did not specify sizes and brands of implanted BP and did not report on post-operative echocardiographic findings.…”

Section: Acute Surgical Results and Primary Endpointscontrasting

confidence: 68%

“…To avoid the need for early re-operation, indication for PVR should be liberal due to the rapid progressive character of CHD. RHF is the main cause of the elevated 30-day mortality in patients who undergo cardiac surgery for CHD [7] . Besides an early referral -while the right ventricular function is still preserved -pulmonary root replacement using stentless BP facilitates implantation of prostheses with larger orifice and better haemodynamic performance [9] , which reduces the risk of RHF.…”

Section: Acute Surgical Results and Primary Endpointsmentioning

confidence: 99%

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Optimized Outcomes Using a Standardized Approach for the Treatment of Patients with Carcinoid Heart Disease

Silaschi¹,

Barr²,

Chaubey³

et al. 2016

Neuroendocrinology

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Background: Carcinoid heart disease (CHD) is common in patients with carcinoid syndrome (CS). Surgical treatment improves the poor prognosis of CHD, although the reported peri-operative mortality is high (∼17%). We attempted to improve outcomes by implementation of a protocol for the management of patients with CHD at a UK Neuroendocrine Centre of Excellence and report our experience. Methods: All patients treated for CHD between 2008 and 2015 were included. Peri-operative treatment included surgical features such as invasive pulmonary valve (PV) inspection and preservation of the tricuspid subvalvular apparatus. Results: A total of 11 patients were treated; the median age was 63 years (IQR: 56-70). Ten patients underwent both pulmonary valve replacement (PVR) and tricuspid valve replacement (TVR); 1 patient underwent isolated TVR. One patient had additional aortic valve replacement (AVR), another one coronary artery bypass grafting. Bioprostheses (BP) were used in all patients, stented for TVR and AVR, stentless for PVR. Invasive PV inspection caused unplanned PVR in 3 cases (27.3%). All patients were discharged home. One patient (9.1%), who had had previous TVR by another surgeon, had right heart failure (RHF) during follow-up. One death occurred due to progression of CS (day 346). The carcinoids' primary was resected in 5 patients (45.5%) 10 months (4.5-19.5) after cardiac surgery. Conclusion: Excellent results were achieved in patients with CHD. PV stenosis can be underestimated by echocardiography; therefore, intraoperative inspection is recommended. Right ventricular geometry should be respected to prevent RHF. BP should be used, as these patients are likely to undergo future non-cardiac surgeries.

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Section: Baseline Characteristics Of Patients With Chdcontrasting

confidence: 88%

Section: Acute Surgical Results and Primary Endpointscontrasting

confidence: 68%

Section: Acute Surgical Results and Primary Endpointsmentioning

confidence: 99%

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Optimized Outcomes Using a Standardized Approach for the Treatment of Patients with Carcinoid Heart Disease

Silaschi¹,

Barr²,

Chaubey³

et al. 2016

Neuroendocrinology

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“…Indirect data pertaining to: (a) the decreased survival span once symptoms of overt HF present [9], (b) the exclusion of patients with severe RHF from cardiac surgery or the unfavorable outcomes in the presence of RHF [42,49], (c) the difference in survival between patients with and without cardiac involvement [8], (d) the improvements in postoperative survival over the last decades [31,35], and (e) the use of novel imaging techniques, such echocardiographic LV and RV strain [50,51], which has been accompanied by incremental diagnostic and prognostic value over traditionally recommended conventional echocardiographic indices, has created a trend toward the application of heart surgery upon echocardiographic detection of CHD, prior to the appearance of symptoms of RHF [52]. However, the recent, large study by Connolly et al [36] failed to demonstrate an independent association between preoperative: (a) presence of advanced HF (NYHA III or IV), (b) signs of RHF (ascites, leg edema), (c) echocardiographic findings of RV dysfunction, and (d) time from carcinoid diagnosis and operation, and cumulative postoperative survival.…”

Section: Current Trends and Unresolved Issuesmentioning

confidence: 99%

Cardiac Surgery for Carcinoid Heart Disease: A Weapon Not to Be Misused

Bonou

Kapelios²,

Kaltsas³

et al. 2016

Cardiology

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Carcinoid heart disease (CHD) complicates approximately 25% of patients with a carcinoid tumor and carcinoid syndrome and leads to heart valve degeneration with mixed-stenotic and regurgitation pathology and consequent heart failure (HF) leading to significant morbidity and mortality. Cardiac surgery in symptomatic, severe CHD leads to significantly better functional capacity and prolonged survival when compared to medical treatment alone. Recent studies have shown improvement in postoperative outcomes of patients undergoing surgery for CHD over the last decades. The trend for early diagnosis and application of surgery prior to the manifestation of HF symptoms, which tended to develop during the previous years, does not seem justifiable based on the findings of recent studies. Therefore, the optimal timing of intervention in CHD and the type of valve that should preferably be used remain issues of controversy. This review comprehensively examines the existing literature on the treatment options for patients with CHD, with a special focus on short- and long-term survival after cardiac surgery, and discusses the selection of the exact patient profile and intervention timing that are more likely to optimize the benefit-to-risk ratio for surgical intervention.

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“…The prognosis for patients with CHD and severe heart failure (NYHA classes III and IV) is unfavourable; the mean survival rate for patients without cardiosurgical treatment is 11 months. The gold standard in CHD diagnosis is echocardiography, which should be performed in all patients with carcinoid syndrome [19][20][21][22][23][24].…”

Section: Symptoms Of the Hormonally Active Nens Of The Small Intestinmentioning

confidence: 99%

Nowotwory neuroendokrynne jelita cienkiego i wyrostka robaczkowego — zasady postępowania (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)

Bolanowski

Bednarczuk²,

Bobek-Billewicz³

et al. 2014

Endokrynologia Polska

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We present revised Polish guidelines regarding the management of patients harbouring neuroendocrine neoplasms (NENs) of the small intestine and appendix. The small intestine, especially the ileum, is the most common origin of these neoplasms. Most of them are well differentiated with slow growth. Rarely, they are less differentiated, growing fast with a poor prognosis. Since symptoms can be atypical, the diagnosis is often accidental. Typical symptoms of carcinoid syndrome occur in less than 10% of patients. The most useful laboratory marker is chromogranin A; 5-hydroxyindoleacetic acid is helpful in the monitoring of carcinoid syndrome. Ultrasound, computed tomography, magnetic resonance imaging, colonoscopy, video capsule endoscopy, balloon enteroscopy and somatostatin receptors scintigraphy are used in the visualisation. A histological report is crucial for the proper diagnostics and therapy of NENs, and it has been extensively described. The treatment of choice is surgery, either radical or palliative. Somatostatin analogues are crucial in the pharmacological treatment of the hormonally active and non-active small intestine NENs and NENs of the appendix. Radioisotope therapy is possible in patients with a good expression of somatostatin receptors. Chemotherapy is not effective in general. Everolimus therapy can be applied in patients with generalised NENs of the small intestine in progression and where there has been a failure or an inability to use other treatment options. Finally, we make recommendations regarding the monitoring of patients with NENs of the small intestine and appendix. (6) w mniej niż 10% przypadków. W diagnostyce laboratoryjnej najbardziej przydatne jest oznaczenie stężenia chromograniny A, badanie stężenia kwasu 5-hydroksyindolooctowego jest pomocne w monitorowaniu zespołu rakowiaka. W obrazowaniu stosuje się ultrasonografię, tomografię komputerową, rezonans magnetyczny, kolonoskopię, wideoendoskopię kapsułkową, enteroskopię dwubalonową, scyntygrafię receptorów somatostatynowych. Szczegółowe badanie histologiczne jest kluczowym dla właściwego rozpoznania i leczenia chorych z NEN jelita cienkiego i wyrostka robaczkowego. Leczeniem z wyboru jest postępowanie chirurgiczne, radykalne lub paliatywne. W leczeniu farmakologicznym czynnych i nieczynnych hormonalnie NEN jelita cienkiego i wyrostka robaczkowego podstawowe znaczenie mają analogi somatostatyny. Terapia radioizotopowa u chorych z dobrą ekspresją receptorów somatostatynowych stanowi kolejną opcję terapeutyczną. Chemioterapia jest na ogół nieskuteczna. U pacjentów z rozsianym NEN jelita cienkiego i progresją choroby oraz nieskutecznością innych metod terapii można zastosować ewerolimus. Przedstawiono także zalecenia odnośnie monitorowania chorych z NEN jelita cienkiego i wyrostka robaczkowego. (Endokrynol Pol 2013; 64 (6): 444-493)

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Cardiac surgery for carcinoid heart disease in 12 cases

Cited by 19 publications

References 23 publications

Optimized Outcomes Using a Standardized Approach for the Treatment of Patients with Carcinoid Heart Disease

Optimized Outcomes Using a Standardized Approach for the Treatment of Patients with Carcinoid Heart Disease

Cardiac Surgery for Carcinoid Heart Disease: A Weapon Not to Be Misused

Nowotwory neuroendokrynne jelita cienkiego i wyrostka robaczkowego — zasady postępowania (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)

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