Early Bioprosthetic Valve Deterioration After Carcinoid Plaque Deposition

Castillo, Javier G.; Filsoufi, Farzan; Rahmanian, Parwis B.; Zacks, Jerome; Warner, Richard R.P.; Adams, David H.

doi:10.1016/j.athoracsur.2008.04.061

Cited by 12 publications

(5 citation statements)

References 3 publications

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“…2,16 However, now more surgeons prefer the bioprosthetic valves for their carcinoid patients. [17][18][19][20][21] Following the revolutionary introduction in 1986 of the somatostatin analog, 22 the major source of morbidity and mortality of patients with carcinoid tumors became cardiac involvement. 1 Patients who have carcinoid disease can survive more than 10 years after diagnosis, because the tumors, although malignant, are slow growing 10,23 ; however, once there is cardiac involvement, the prognosis is signifi cantly worse.…”

Section: Discussionmentioning

confidence: 99%

Cardiac surgery for carcinoid heart disease in 12 cases

Komoda

Pavel

et al. 2011

Gen Thorac Cardiovasc Surg

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Section: Discussionmentioning

confidence: 99%

Cardiac surgery for carcinoid heart disease in 12 cases

Komoda

Pavel

et al. 2011

Gen Thorac Cardiovasc Surg

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“…In our patient, cardiac surgery facilitated a clinical improvement and let the patient be safely operated on for an abdominal tumor. However, at follow-up, we observed deterioration of the tricuspid valve, which could result from the delay between cardiac and abdominal surgery and exposure of the prosthetic valve to high levels of serotonin metabolites before tumor resection [5]. Our results show the need for immediate tumor resection after valvular replacement and strict observation of the tricuspid prosthesis structure and function at follow-up.…”

Section: Staged Treatment Of Carcinoid Syndrome Complicated With Seve...mentioning

confidence: 65%

Staged treatment of carcinoid syndrome complicated with severe tricuspid regurgitation

et al. 2022

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“…This degenerative phenomenon has been noted in other studies of explanted PV autografts and has been thought to derive mostly from myofibroblast and endothelial stress ( 29 , 30 ). We acknowledge that, traditionally, carcinoid syndrome patients’ with carcinoid heart disease present, as expected, with both PV and TV deterioration, as they are off treatment or inadequately treated (e.g., with somatostatin analogs) ( 31 ). Early increase in velocities after surgery at the pulmonic valve level at almost pre-procedure levels, however, suggest the possibility of plaque deposition specifically–and in higher concentration–at the pulmonic valve level.…”

Section: Discussionmentioning

confidence: 80%

Bioprosthetic valve monitoring in patients with carcinoid heart disease

Honan

Hassan²,

Deswal³

et al. 2023

Front. Cardiovasc. Med.

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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.

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Early Bioprosthetic Valve Deterioration After Carcinoid Plaque Deposition

Cited by 12 publications

References 3 publications

Cardiac surgery for carcinoid heart disease in 12 cases

Cardiac surgery for carcinoid heart disease in 12 cases

Staged treatment of carcinoid syndrome complicated with severe tricuspid regurgitation

Bioprosthetic valve monitoring in patients with carcinoid heart disease

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