Objective

Carcinoid heart disease (CHD) is common in patients with carcinoid syndrome (CS). Surgical treatment improves the poor prognosis of CHD, although the reported perioperative mortality is high (~17%). We attempted to improve outcomes by implementation of a protocol for the management of patients with CHD at a UK Neuroendocrine Center of Excellence and report our experience.

Methods

All patients treated for CHD between 2008 and 2015 were included. A total of 11 patients were treated, median age was 63 years (IQR:56-70). Peri-operative treatment included surgical features such as invasive pulmonary valve (PV) inspection and preservation of the tricuspid subvalvular apparatus.

Results

In 10 patients both pulmonary (PVR) and tricuspid valve (TVR) were replaced, one patient underwent isolated TVR. One patient had additional aortic valve replacement (AVR), and one coronary artery bypass grafting. Bioprostheses (BP) were used in all patients, stented for TVR and AVR, stentless for PVR. Invasive PV inspection caused unplanned PVR in 27.3%. One death occurred due to progression of CS (day 346). The tumour primary was resected in 45.5% 10 months (4.5-19.5) after cardiac surgery.

Conclusion

Excellent results were achieved in patients with CHD. PV stenosis can be underestimated by echocardiography, therefore intraoperative inspection is recommended. Right ventricular geometry should be respected to prevent RHF. BP should be used, as these patients are likely to undergo future non-cardiac surgeries.