title: Outcomes, risks and complications of cardiac surgery for carcinoid heart disease.
abstract: OBJECTIVE
  The development of carcinoid heart disease causes significant valvular dysfunction, eventually leading to symptomatic right heart failure and impaired survival. Data regarding cardiovascular surgery are limited. We sought to identify outcomes, risks and complications of valve surgery for carcinoid heart disease.
  
  
  METHODS
  Twenty-two patients with carcinoid heart disease underwent cardiac valve surgery between 2006 and 2010. Patients were considered for surgery if (1) they had stable carcinoid tumour, (2) they had severe valvular dysfunction and (3) were symptomatic and (4) they had no other significant co-morbidities. Three patients underwent tricuspid valve replacement alone, 15 patients underwent tricuspid and pulmonary valve replacement, two patients underwent tricuspid, pulmonary and mitral valve replacement and two patients underwent quadruple valve replacement.
  
  
  RESULTS
  Overall 30-day mortality was 18%. Causes of death were right ventricular dysfunction (two patients), carcinoid crises (one patient) and pneumonia (one patient). Four patients required permanent pacemaker for complete heart block. Of those that survived initial surgery, median follow-up was 26 months (interquartile range 8-42); 1- and 2-year survival rates were 56% and 44%, respectively. There was no significant difference in survival between those patients in the New York Heart Association (NYHA) class I/II, mild/moderate right ventricular dilatation or N-terminal brain natriuretic peptide (NT-proBNP) <1245 pg ml(-1) compared with those in NYHA class III/IV, severe right ventricular enlargement or NT-proBNP > 1245 pg ml(-1), respectively. Long-term causes of death were related to advanced metastatic carcinoid tumour. No patient required re-operation for bioprosthetic degeneration.
  
  
  CONCLUSIONS
  Valve surgery for carcinoid heart disease is of higher risk compared with most other forms of valvular surgery. However, in those that survive the operation significant improvement in functional class occurs. Most long-term complications were related to the tumour itself rather than cardiac complications.
authors.affiliation: Department of Cardiology, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Bhattacharyya
authors.forename: Shahzad G
authors.initials: SG
authors.lastname: Raja
authors.forename: Christos
authors.initials: C
authors.lastname: Toumpanakis
authors.forename: Martyn E
authors.initials: ME
authors.lastname: Caplin
authors.forename: Gilles D
authors.initials: GD
authors.lastname: Dreyfus
authors.forename: Joseph
authors.initials: J
authors.lastname: Davar
mesh_terms: D000368:Aged; D002275:Carcinoid Heart Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D004812:Epidemiologic Methods; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery; D011379:Prognosis; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000601:surgery; D014463:Ultrasonography