title: Effect of Valvular Surgery in Carcinoid Heart Disease: An Observational Cohort Study.
abstract: BACKGROUND
  Carcinoid heart disease (NET-CHD) is associated with the development of symptom-limited exercise capacity and high rates of morbidity and mortality.
  
  
  OBJECTIVE
  This study sought to determine the survival, cardiac function, and functional class following surgery.
  This was a retrospective observational cohort study between 2005 and 2015 at a European Centre of Excellence for Neuroendocrine Tumours, Queen Elizabeth Hospital Birmingham. England consisting of 62 consecutive patients referred to the NET-Cardiology Service.
  
  
  METHODS
  Subjects were assessed at referral using transthoracic echocardiography (with saline contrast) and transesophageal echocardiography, and 77% with confirmed NET-CHD underwent cardiovascular magnetic resonance imaging. Symptomatic patients with concomitant severe valvular dysfunction were referred for surgery with stable NET disease.
  
  
  METHODS
  Survival of patients with proven NET-CHD following medical and surgical treatments was measure.
  
  
  RESULTS
  In total, 47/62 patients were diagnosed with NET-CHD. Thirty-two patients (68%) underwent surgery with bioprosthetic valve replacements in all subjects; tricuspid, n = 31; pulmonary, n = 30; mitral, n = 3; and aortic, n = 3. Four patients underwent concomitant coronary artery bypass grafting. There were 4 (13%) early post-operative deaths. One- and 2-y survival rates after surgery were 75 and 69% compared with 45 and 15% in un-operated patients. Post-operatively, functional class was improved (pre-New York Heart Association Classification [NYHA], 2.6 [0.5] vs post-NYHA, 1.7 [1.1]), P < .05, right-ventricular (RV) size was reduced (136 ml/m(2) [25] vs 71 ml/m(2) [7]; P < .01) with preserved RV ejection fraction (61% ± 9 vs 55% ± 10; P = .26).
  
  
  CONCLUSIONS
  Valve surgery improved functional class and resulted in RV reverse remodelling with improved survival rates at 2 y compared with those not proceeding to operation. These data highlight the importance of close collaboration between NET clinicians, cardiology, and cardiothoracic surgery teams. Early referral can improve functional capacity but more research is needed to define the selection of appropriate candidates and randomized data are needed to define the effect of surgery on prognosis.
authors.affiliation: Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom.
authors.forename: N C
authors.initials: NC
authors.lastname: Edwards
authors.affiliation: Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Yuan
authors.affiliation: Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom.
authors.forename: O
authors.initials: O
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authors.affiliation: Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom.
authors.forename: T A
authors.initials: TA
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authors.affiliation: Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom.
authors.forename: T
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authors.affiliation: Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom.
authors.forename: H
authors.initials: H
authors.lastname: Singh
authors.affiliation: Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom.
authors.forename: H
authors.initials: H
authors.lastname: Mehrzad
authors.affiliation: Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom.
authors.forename: Z
authors.initials: Z
authors.lastname: Zia
authors.affiliation: Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom.
authors.forename: J I
authors.initials: JI
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authors.affiliation: Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom.
authors.forename: D H
authors.initials: DH
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authors.affiliation: Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom.
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authors.initials: CJ
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authors.affiliation: Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom.
authors.forename: J
authors.initials: J
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authors.affiliation: Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom.
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authors.affiliation: Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom.
authors.forename: S J
authors.initials: SJ
authors.lastname: Rooney
authors.affiliation: Departments of Cardiology (N.C.E., M.Y., O.N., T.A.P., R.P.S.), Anaesthesia (T.O., H.S.), Radiology (H.M., Z.Z.), Oncology (J.I.G.), Endocrinology (C.J.H.M., J.A.), Hepatology (T.S.), and Cardiothoracic Surgery (S.J.R.), Queen Elizabeth Hospital Birmingham, Birmingham B15 2TT, United Kingdom; and Department of Molecular and Clinical Cancer Medicine (D.H.P.), University of Liverpool, Liverpool L69 3BX, United Kingdom.
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authors.initials: RP
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mesh_terms: D000368:Aged; D001705:Bioprosthesis; D002275:Carcinoid Heart Disease / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013318:Stroke Volume; D016019:Survival Analysis; D016896:Treatment Outcome