Predictors of outcome of tricuspid valve replacement in carcinoid heart disease

Robiolio, Paul A.; Rigolin, Vera H.; Harrison, J. Kevin; Lowe, James E.; Moore, Joseph O.; Bashore, Thomas M.; Feldman, Jerome M.

doi:10.1016/s0002-9149(99)80586-4

Cited by 79 publications

(30 citation statements)

References 33 publications

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“…In 1995, Connolly et al 7 reported that despite high perioperative mortality, a trend toward improved longterm outcome was achieved in patients managed surgically. A high perioperative mortality has also been reported by Robiolio et al, 23 especially in carcinoid patients over the age of 60 years. The present study demonstrates that the perioperative mortality rate has been reduced from Ͼ20% to currently Ͻ10%.…”

Section: Møller Et Al Prognosis Of Carcinoid Heart Disease 3323mentioning

confidence: 53%

Prognosis of Carcinoid Heart Disease

et al. 2005

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Background— The long-term prognosis of patients who develop carcinoid heart disease and the effect of cardiac surgery on outcome are not well established. Methods and Results— In this retrospective study, we identified 200 patients with carcinoid syndrome referred for echocardiography in whom the diagnosis of carcinoid heart disease was confirmed. Patients were divided into 3 groups of similar size according to the date from first diagnosis of carcinoid heart disease. Group A comprised patients diagnosed from 1981 through June 1989; group B, diagnosed July 1989 through May 1995; and group C, June 1995 through 2000. The end point was all-cause mortality. Median survival was significantly lower in group A (1.5 years, 95% CI 1.1 to 1.9 years) compared with groups B (3.2, 95% CI 1.3 to 5.1 years) and C (4.4, 95% CI 2.4 to 7.1 years; P =0.009). In a multivariate model adjusted for treatment and clinical characteristics, the risk of death in groups B (hazard ratio 0.67, 95% CI 0.46 to 0.99, P =0.04) and C (hazard ratio 0.61, 95% CI 0.39 to 0.92, P =0.006) was significantly reduced relative to group A. Cardiac surgery was performed in 87 patients. When cardiac surgery was included as a time-dependent covariate in a multivariate analysis, it was associated with a risk reduction of 0.48 (95% CI 0.31 to 0.73, P <0.001), whereas the time period of diagnosis was no longer significant. Conclusions— The prognosis of patients with recognized carcinoid heart disease has improved over the past 2 decades at our institution. This change in survival may be related to valve replacement surgery.

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Section: Møller Et Al Prognosis Of Carcinoid Heart Disease 3323mentioning

confidence: 53%

Prognosis of Carcinoid Heart Disease

et al. 2005

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“…As might be expected, early operative mortality in these patients with multivalvular involvement and advanced metastatic tumor is higher than that expected for the usual patient having valve replacement or repair but is comparable to other series of cardiac surgery in carcinoid heart disease. 13 Third, despite the presence of left-sided valve disease, the patients in this series presented primarily with right heart failure. Fourth, prolonged survival and functional improvement were noted in most of the surgical survivors.…”

Section: Present Studymentioning

confidence: 81%

Surgical Management of Left-Sided Carcinoid Heart Disease

Connolly¹,

Schaff²,

Mullany³

et al. 2001

Circulation

106

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Background-Carcinoid involvement of left-sided heart valves has been reported in patients with a patent foramen ovale, carcinoid tumor of the lung, and active carcinoid syndrome with high levels of serotonin. The present study details the clinical features and surgical management of patients with carcinoid heart disease affecting both left-and right-sided valves. Methods and Results-Eleven patients (7 men, 4 women) with symptomatic carcinoid heart disease underwent surgery for left-and right-sided valve disease between 1989 and 1999. Mean age was 57Ϯ9 years, and median preoperative NYHA class was 3. All patients had metastatic carcinoid tumors and were on somatostatin analog. Of 11 patients, 5 (45%) had a patent foramen ovale; 1 of these also had a primary lung carcinoid tumor. Surgery included tricuspid valve replacement in all patients, pulmonary valve replacement in 3 and valvectomy in 7, mitral valve replacement in 6 and repair in 1, aortic valve replacement in 4 and repair in 2, CABG in 2, and patent foramen ovale closure in 5. One myocardial metastatic carcinoid tumor was removed. There were 2 perioperative deaths. At a mean follow-up of 41 months, 4 additional patients were dead. All but 1 surgical survivor initially improved Ն1 functional class. No patient required reoperation. Conclusions-Carcinoid heart disease may affect left-and right-sided valves and occurred without intracardiac shunting in 55% of this surgical series. Despite metastatic disease that limits longevity, operative survivors had improvement in functional capacity. Cardiac surgery should be considered for select patients with carcinoid heart disease affecting leftand right-sided valves.

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“…Peri-operative mortality Number of patients Robiolio et al (1995) Peri-operative mortality: mortality rate the first 30 days after surgery for carcinoid heart disease. …”

Section: Overall Survivalmentioning

confidence: 99%

Effect of hormone secretory syndromes on neuroendocrine tumor prognosis

Zandee

Kamp

Adrichem

et al. 2017

Endocrine-Related Cancer

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The treatment of hormone hypersecretory syndromes caused by neuroendocrine tumors (NETs) can be a major challenge. NETs originating from the small intestine often secrete serotonin causing flushing, diarrhea and valve fibrosis, leading to dehydration or heart failure in severe cases. NETs from the pancreas can secrete a wider variety of hormones, like insulin, glucagon and gastrin leading to distinct clinical syndromes. Historically mortality in patients with functioning NETs was high due to the complications caused by the hypersecretion of hormones. This has been reduced with several drugs: protonpump inhibitors decrease acid secretion caused by gastrinomas. Somatostatin analogs can inhibit the secretion of multiple hormones and these are now the cornerstone for treating patients with a gastroenteropancreatic NET. However, peptide receptor radionuclide therapy (PRRT) with radiolabeled somatostatin analogs and everolimus can also decrease symptoms of hypersecretion and increase progression-free survival. Several factors affect the survival in patients with a functioning NET. Complications of hypersecretion negatively impact survival; however, secretion of hormones is also often a sign of a well-differentiated NET and due to the symptoms, functioning NETs can be detected in an earlier stage suggesting a positive effect on prognosis. The effect on survival is also dependent on the type of hormone being secreted. This review aims to study the effect of hormone secretion on the prognosis of NETs with the contemporary treatments options available today.

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Predictors of outcome of tricuspid valve replacement in carcinoid heart disease

Cited by 79 publications

References 33 publications

Prognosis of Carcinoid Heart Disease

Prognosis of Carcinoid Heart Disease

Surgical Management of Left-Sided Carcinoid Heart Disease

Effect of hormone secretory syndromes on neuroendocrine tumor prognosis

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