Incidence of Atrioventricular Block After Valve Replacement in Carcinoid Heart Disease

Abstract

Background: Carcinoid heart disease (CaHD) is a rare condition that has a high impact on the morbidity and mortality of its patients. Once heart failure symptoms develop in the patient with CaHD, cardiac valve surgery is often the only effective treatment. Although atrioventricular block (AVB) is a known postoperative complication of the valve surgery, the incidence of AVB in this population has not been well described. Methods:Comprehensive records were collected retrospectively on consecutive patients with CaHD who underwent a valve surgery at a tertiary medical center from January 2001 to December 2015. We excluded patients with pre-existing permanent pacemaker (PPM). Results:Nineteen consecutive patients were included in this study and 18 of them underwent at least dual valve (tricuspid and pulmonary valve) replacement surgery. Our 30-day post-surgical mortality was 0%. During the 6-month observation period following the surgery, 31.5% (n = 6) required PPM implantation due to complete AVB. There was no statistical difference in baseline characteristics and electrocardiographic and echocardiographic parameters between the patients who did or did not require PPM placement. Conclusions:Our study revealed that almost one-third of CaHD patients who underwent a valve replacement surgery developed AVB requiring PPM implantation. Due to high incidence of PPM require-ment, we believe that prophylactic placement of an epicardial lead during the valve surgery can be helpful in these patients to reduce serious complication from placement of pacemaker lead on a later date through a prosthetic valve.

2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS)

“…784,785 Complications include AV block, requiring pacemaker implantation in 25% of patients. 786 Frequently, the reduced RV function does not improve despite tricuspid valve replacement and HF persists. 787 Thrombus formation on the tricuspid bioprosthesis can occur, especially during the first 3 months post-operatively, and oral anticoagulation with VKA may be considered.…”

Simultaneous Tricuspid and Pulmonic Valve Replacement Due to Infective Endocarditis

“…This is likely explained by the proximity of the tricuspid valve to the AV node, which may often undergo surgical injury or become disrupted due to cardiac tissue edema. One study reported the need for PPM placement in 21-22% of patients who underwent cardiac surgery involving the tricuspid valve [ 6 ]. No definitive guidelines have been published for when a permanent pacemaker (PPM) should be implanted, but current literature generally recommends PPM placement no earlier than 5-7 days from the date of surgery.…”

Carcinoid Heart Disease – A Review of Pathophysiology, Clinical Manifestations, Diagnosis and Management

“…Pacemaker implantation is safe and can be accomplished with minimal complications. The risk of heart block persists until 6 months after right sided valve surgery; consequently, some authors have recommended prophylactic placement of epicardial leads after surgery [58]. Heart block can rarely occur in the setting of intracardiac metastasis from a carcinoid tumor [59].…”