Outcomes of surgical treatment for carcinoid heart disease: A systematic review and meta-analysis

European Neuroendocrine Tumor Society (ENETS) 2022 Guidance Paper for Carcinoid Syndrome and Carcinoid Heart Disease

“…71 • The feasibility of quadruple valve replacement leading to marked functional improvement has also been reported by several groups. 66 • In a recent metanalysis 74 TR is usually the predominant lesion in CHD, and all patients with severe TR are candidates for TVR unless surgery is contraindicated.…”

“…PVR with patch enlargement of the right ventricular outflow tract is performed for management of PR and to facilitate implantation of the PV prosthesis of optimal size. 74 Mitral valve replacement (MVR) may be performed, depending on the severity of mitral valve (MV) involvement.…”

“…In a recent metanalysis 74 consisting of 416 pre‐operative patients, 97% had moderate or severe TR, 72% moderate or severe PR, and 33% with PS with or without regurgitation. Left heart characteristics included mitral valve regurgitation (MR) in 24% and aortic valve regurgitation (AR) in 18% of patients. TR is usually the predominant lesion in CHD, and all patients with severe TR are candidates for TVR unless surgery is contraindicated. PVR with patch enlargement of the right ventricular outflow tract is performed for management of PR and to facilitate implantation of the PV prosthesis of optimal size 74 …”

“…In a recent metanalysis 74 consisting of 416 pre‐operative patients, 97% had moderate or severe TR, 72% moderate or severe PR, and 33% with PS with or without regurgitation. Left heart characteristics included mitral valve regurgitation (MR) in 24% and aortic valve regurgitation (AR) in 18% of patients. TR is usually the predominant lesion in CHD, and all patients with severe TR are candidates for TVR unless surgery is contraindicated. PVR with patch enlargement of the right ventricular outflow tract is performed for management of PR and to facilitate implantation of the PV prosthesis of optimal size 74 Mitral valve replacement (MVR) may be performed, depending on the severity of mitral valve (MV) involvement. Aurtic valve replacement (AVR) is the option for CHD involvement of the aortic valve (AV). …”

“…In a recent metanalysis 74 consisting of 416 pre‐operative patients, 97% had moderate or severe TR, 72% moderate or severe PR, and 33% with PS with or without regurgitation. Left heart characteristics included mitral valve regurgitation (MR) in 24% and aortic valve regurgitation (AR) in 18% of patients. TR is usually the predominant lesion in CHD, and all patients with severe TR are candidates for TVR unless surgery is contraindicated. PVR with patch enlargement of the right ventricular outflow tract is performed for management of PR and to facilitate implantation of the PV prosthesis of optimal size 74 Mitral valve replacement (MVR) may be performed, depending on the severity of mitral valve (MV) involvement. Aurtic valve replacement (AVR) is the option for CHD involvement of the aortic valve (AV). Additional procedures include PFO closure and removal of intramyocardial metastasis. The presence of a PFO should always be researched during surgery (and closed if present) even if not diagnosed during the pre‐operative assessment. Because of increased risk of development of high‐degree AV block post TV replacement, it is common practice to implant RV epicardial and right atrial (if in sinus rhythm prior to surgery and for possibility of A‐V sequential pacing) pacing wires 75 .…”