Abstract 15478: Incidence of Atrioventricular Block Following Dual Valve Replacement in Carcinoid Heart Disease
Introduction: Carcinoid heart disease (CaHD) is a rare condition that has a high impact on the morbidity and mortality of its patients. Cardiac valve surgery is often the only effective treatment. Post-surgical mortality has been reduced over the past 20 years but arrhythmias, disease progression and worsening heart failure still account for a 30-day mortality range of 5-15%. Although atrioventricular block (AVB) is a known postoperative complication of cardiac valve replacement surgery, the incidence and predictors of AVB in this population have not been well described.
Hypothesis: We hypothesize that patients with CaHD who undergo dual tricuspid and pulmonic valve replacement have a high incidence of AVB.
Methods: Comprehensive records were collected on consecutive patients presenting for cardiac surgery evaluation with carcinoid heart disease at a single university-affiliated medical center from January 2001 to December 2015. Patients with prior permanent pacemaker placement or inability to collect data in a full 6-month period were excluded. Complete clinical, surgical, and demographic data were collected and analyzed retrospectively. EKGs and echocardiograms pre and post-surgery were collected and analyzed.
Results: We identified 27 patients with CaHD. Three patients were non-surgical candidates due to disease progression. Of the 24 patients included in the final analysis, 18 underwent at least dual valve replacement (tricuspid and pulmonic valve) with bio-prosthetic implants. All 18 patients had heart failure with symptomology consistent with NYHA class III/IV. Of those requiring dual valve replacement, nearly 40% (7/18 patients) required pacemaker implantation following surgery due to high degree (29%; 2/7) or third degree (71%; 5/7) heart block within 4.3 ± 3.7 days. Our 30-day post-surgical mortality was 0.
Conclusions: This is the first report of the incidence of AVB after dual valve surgery in CaHD. Given the high incidence of AVB in the CaHD population when compared to the general population following cardiac valve surgery, prophylactic placement of an epicardial right ventricular lead during valvular surgery should be considered to prevent repeat thoracotomy or placement of a lead at a later date through an artificial valve.
Author Disclosures: I. Sunjic: None. J.V. Popat: None. T. Tran: None. S. Chae: None. C.C. Caldeira: None. J.R. Strosberg: None. D. Sayad: None.
- © 2016 by American Heart Association, Inc.