Background: The prosthetic valve of choice in patients with Carcinoid Valve Disease (CVD) remains controversial due to the limited life expectancy of patients with advanced-stage neuroendocrine tumors (NETs) on one hand, and concerns regarding structural valve deterioration (SVD) on the other.
Methods: We retrospectively reviewed the case records of 9 patients with primarily right heart failure (5 females, mean age 68±11 years, NYHA class III-IV) due to CVD treated at our institution. All patients received somatostatin analogues perioperatively. Isolated right-sided valve operations were conducted on a beating-heart assisted by cardiopulmonary bypass. Hospital and follow-up (direct patient contact, echocardiography) data collected included baseline characteristics, procedural profiles and clinical outcomes.
Results: The primary NET site was ileum – 6, lung – 2 and appendix -1. Preoperative urine levels of 5-HIAA(61±36 mg/24h) and serum levels of chromogranin A (2926±4057 ng/ml) were 10 and 50 times greater than normal, respectively. A total of 13 valve prostheses were implanted – isolated tricuspid valve (TVR) – 5 patients (mechanical - 1), TVR and pulmonary valve (PVR) – 3 (all tissue), and TVR and mitral valve replacement (MVR) – 1(mechanical). There was no hospital mortality, carcinoid crisis, or a need for permanent pacemaker. Reexploration for bleeding was required in 2 patients. Mean follow up was 22±18 months (range 3-56 months). Four patients developed structural tissue valve deterioration (SVD) at 12, 16, 21 and 24 months after surgery, three of whom expired, and the 4th is in NYHA class IV. An additional patient expired due to multi-organ failure. Actuarial 4-year survival and freedom from SVD were 25±2% and 21±2%, respectively.
Conclusion:These data suggest that the main advantage of tissue valve prostheses – avoiding lifelong, intense anticoagulation, might be offset by accelerated SVD. The use of mechanical valves should be considered in CVD patients with a large tumor mass and persistent high levels of NETs markers, in whom adequate control of hormonal secretion is difficult.
