PMID- 31383543
OWN - NLM
STAT- MEDLINE
DCOM- 20210120
LR  - 20210120
IS  - 1444-2892 (Electronic)
IS  - 1443-9506 (Linking)
VI  - 29
IP  - 5
DP  - 2020 May
TI  - Early Outcomes of Surgery for Carcinoid Heart Disease.
PG  - 742-747
LID - S1443-9506(19)30606-7 [pii]
LID - 10.1016/j.hlc.2019.05.183 [doi]
AB  - BACKGROUND: The prognosis of patients with metastatic neuroendocrine neoplasms 
      (NEN) continues to improve with modern oncological therapy. In the subgroup of 
      patients with carcinoid syndrome, the development of carcinoid heart disease 
      (CaHD) severely impacts long term survival. Valve surgery has been demonstrated 
      to improve survival and symptoms in patients with CaHD. We sought to assess the 
      outcomes of surgery for CaHD from a single Neuroendocrine Service. METHODS: We 
      retrospectively reviewed outcomes of patients with CaHD and metastatic NEN who 
      underwent valvular surgery over a 4-year period (2012-2016). RESULTS: Twenty (20) 
      patients (mean age 64 years, range 29-77 years), all with metastatic small 
      intestinal NEN treated with somatostatin analogues, underwent surgery. Tumour 
      grade was: G1 (n=8), G2 (n=9), and unknown (n=3). Preoperative New York Heart 
      Association (NYHA) class was III/IV in 15 patients (75%). The valves affected 
      were: tricuspid (n=20; 19 replace, 1 repair), pulmonary (n=14; 14 replace), 
      mitral (n=2; two replace) and aortic valve (n=2; two replace). Concomitant 
      procedures included patent foramen ovale closure (n=9), right ventricular outflow 
      tract (RVOT) (n=4) augmentation and coronary artery bypass grafting (n=3). There 
      were two operative deaths (10%) due to right heart and liver failure. At 6 weeks, 
      all surviving patients had symptom improvement (NYHA I/II). Median follow-up was 
      2+/-1.5 years (<1 month to 5 years). One asymptomatic patient developed RVOT 
      obstruction after pulmonary replacement. Two patients had valvular recurrence. 
      One and 2-year survival were 74% and 48% respectively. Of 13 late deaths, 12 were 
      cancer-related (two with uncorrected progressive pulmonary regurgitation). 
      CONCLUSIONS: Surgery for CaHD can be performed with satisfactory early results, 
      leading to an improvement of cardiac symptoms, survival and enabling subsequent 
      oncologic treatment. Further studies are required to improve longer term outcomes 
      in these complex patients with CaHD.
CI  - Copyright (c) 2019. Published by Elsevier B.V.
FAU - Yong, Matthew S
AU  - Yong MS
AD  - Department of Cardiac Surgery and Cardiology, Epworth Richmond Hospital, 
      Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia.
FAU - Kong, Grace
AU  - Kong G
AD  - Neuroendocrine Tumour Service, Peter MacCallum Cancer Centre, Melbourne, Vic, 
      Australia; Nuclear Medicine Department, Peter MacCallum Cancer Centre, Melbourne, 
      Vic, Australia; Sir Peter MacCallum Department of Oncology, The University of 
      Melbourne, Melbourne, Vic, Australia.
FAU - Ludhani, Prakash
AU  - Ludhani P
AD  - Department of Cardiothoracic Surgery and Cardiology, Royal Melbourne Hospital, 
      Melbourne, Vic, Australia.
FAU - Michael, Michael
AU  - Michael M
AD  - Neuroendocrine Tumour Service, Peter MacCallum Cancer Centre, Melbourne, Vic, 
      Australia; Sir Peter MacCallum Department of Oncology, The University of 
      Melbourne, Melbourne, Vic, Australia; Department of Medical Oncology, Peter 
      MacCallum Cancer Centre, Melbourne, Vic, Australia.
FAU - Morgan, John
AU  - Morgan J
AD  - Department of Cardiac Surgery and Cardiology, Epworth Richmond Hospital, 
      Melbourne, Vic, Australia; Department of Cardiothoracic Surgery and Cardiology, 
      Royal Melbourne Hospital, Melbourne, Vic, Australia.
FAU - Hofman, Michael S
AU  - Hofman MS
AD  - Neuroendocrine Tumour Service, Peter MacCallum Cancer Centre, Melbourne, Vic, 
      Australia; Nuclear Medicine Department, Peter MacCallum Cancer Centre, Melbourne, 
      Vic, Australia; Sir Peter MacCallum Department of Oncology, The University of 
      Melbourne, Melbourne, Vic, Australia.
FAU - Hicks, Rodney J
AU  - Hicks RJ
AD  - Neuroendocrine Tumour Service, Peter MacCallum Cancer Centre, Melbourne, Vic, 
      Australia; Nuclear Medicine Department, Peter MacCallum Cancer Centre, Melbourne, 
      Vic, Australia; Sir Peter MacCallum Department of Oncology, The University of 
      Melbourne, Melbourne, Vic, Australia.
FAU - Larobina, Marco
AU  - Larobina M
AD  - Department of Cardiac Surgery and Cardiology, Epworth Richmond Hospital, 
      Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia; 
      Department of Cardiothoracic Surgery and Cardiology, Royal Melbourne Hospital, 
      Melbourne, Vic, Australia. Electronic address: marco.larobina@mh.org.au.
LA  - eng
PT  - Journal Article
DEP - 20190612
PL  - Australia
TA  - Heart Lung Circ
JT  - Heart, lung & circulation
JID - 100963739
SB  - IM
MH  - Adult
MH  - Aged
MH  - Carcinoid Heart Disease/mortality/*surgery
MH  - Cardiac Surgical Procedures/*methods
MH  - Echocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/mortality
MH  - Prognosis
MH  - Retrospective Studies
MH  - Survival Rate/trends
MH  - Time Factors
MH  - Victoria/epidemiology
OTO - NOTNLM
OT  - Carcinoid heart disease
OT  - Heart valves
OT  - Neuroendocrine tumour
OT  - Surgery
EDAT- 2019/08/07 06:00
MHDA- 2021/01/21 06:00
CRDT- 2019/08/07 06:00
PHST- 2019/01/25 00:00 [received]
PHST- 2019/05/23 00:00 [accepted]
PHST- 2019/08/07 06:00 [pubmed]
PHST- 2021/01/21 06:00 [medline]
PHST- 2019/08/07 06:00 [entrez]
AID - S1443-9506(19)30606-7 [pii]
AID - 10.1016/j.hlc.2019.05.183 [doi]
PST - ppublish
SO  - Heart Lung Circ. 2020 May;29(5):742-747. doi: 10.1016/j.hlc.2019.05.183. Epub 
      2019 Jun 12.