title: Role of hepatic resection for patients with carcinoid heart disease.
abstract: OBJECTIVE
  To evaluate the effects of resection of hepatic carcinoid metastases on progression and prognosis of carcinoid heart disease.
  
  
  METHODS
  From our database of 265 consecutive patients diagnosed as having carcinoid heart disease from January 1, 1980, through December 31, 2005, we calculated survival from first diagnosis of cardiac involvement. Hepatic resection during follow-up was entered as a time-dependent covariable in a multivariable analysis. In patients with serial echocardiograms more than 1 year apart without intervening cardiac surgery, a previously validated cardiac severity score was calculated. A score increase that exceeded 25% was considered relevant progression.
  
  
  RESULTS
  Hepatic resection was performed in 31 patients (12%) during follow-up. Five-year survival was significantly higher in these patients (86.5%; 95% confidence interval [CI], 73.5%-100.0%) than in patients without hepatic resection (29.0%; 95% CI, 23.3%-36.1%; univariable hazard ratio for hepatic resection, 0.25; 95% CI 0.12-0.53; P<.001). Hepatic resection remained strongly associated with improved prognosis in multivariable analysis (hazard ratio, 0.31; 95% CI, 0.14-0.66; P=.003). Among 77 patients (29%) with serial echocardiograms, 10 (13%) underwent hepatic resection during follow-up; resection was independently associated with decreased risk of cardiac progression (odds ratio, 0.29; 95% CI, 0.06-0.75; P=.03).
  
  
  CONCLUSIONS
  Despite the limitations of this retrospective nonrandomized study, our data suggest that patients with carcinoid heart disease who undergo hepatic resection have decreased cardiac progression and improved prognosis. Eligible patients should be considered for hepatic surgery.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
authors.forename: Alain M
authors.initials: AM
authors.lastname: Bernheim
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Connolly
authors.forename: Joseph
authors.initials: J
authors.lastname: Rubin
authors.forename: Jacob E
authors.initials: JE
authors.lastname: Møller
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Scott
authors.forename: David M
authors.initials: DM
authors.lastname: Nagorney
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
mesh_terms: D000368:Aged; D002275:Carcinoid Heart Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014463:Ultrasonography