Abstract 20034: Fate of the Native Pulmonary Valve in Patients With Carcinoid Heart Disease After Tricuspid Valve Replacement
Background: Carcinoid heart disease most frequently affects the right sided valves. In carcinoid patients undergoing tricuspid valve replacement, uncertainty exists regarding the surgical management of pulmonary valve disease in the absence of severe pulmonary valve dysfunction. We aimed to determine the long-term fate of the native pulmonary valve after tricuspid valve replacement (TVR) for carcinoid heart disease.
Methods and results: A retrospective review of 222 surgical patients, operated at our institution between 1985 - 2015, identified 34 patients who underwent TVR without pulmonary valve intervention. After exclusion of 17 patients with < 12 month echocardiographic follow up and 2 with severe pulmonary regurgitation (PR) at baseline, 15 patients were included in the final analysis. The maximum duration of follow up was 112 months, the mean age was 64 +/- 9 years and 53% were female. One patient underwent concomitant aortic and mitral valve replacement, 1 patient mitral valve repair, and 1 aortic valve repair. All patients received octreotide with a median 5-HIAA of 67 (range 15 - 542) mg/24 hours at the time of pre-cardiac surgical evaluation. At a median follow-up of 33 (IQR 26 - 47) months, no patient developed severe PR or a significant change in PR severity, defined as a 2 grade increase in severity. No patients developed severe pulmonary valve stenosis. Re-do cardiac surgery was performed in 1 patient for surgical tricuspid re-replacement, although no patients underwent pulmonary valve replacement during the follow up period. All cause mortality is as shown in the Figure.
Conclusions: Although rare, tricuspid carcinoid valve disease without pulmonary valve involvement at cardiac surgery was associated with a low risk of subsequent pulmonary valve dysfunction and need for subsequent surgical intervention. Hence, it is reasonable to perform TVR without concomitant pulmonary valve intervention, when preoperative testing demonstrates moderate or less PR.
Author Disclosures: S.A. Luis: None. P.A. Pellikka: None. H.V. Schaff: None. H.M. Connolly: None.
- © 2016 by American Heart Association, Inc.