TY - JOUR
T1 - Bioprosthetic valve monitoring in patients with carcinoid heart disease
AU - Honan, Kevin A.
AU - Hassan, Saamir
AU - Deswal, Anita
AU - Herrmann, Joerg
AU - Song, Juhee
AU - Monlezun, Dominique
AU - Halperin, Daniel
AU - Mahvash, Armeen
AU - Dasari, Arvind
AU - Koutroumpakis, Efstratios
AU - Akay, Mehmet
AU - Balanescu, Dinu Valentin
AU - de Armas, Ismael Salas
AU - Patel, Manish
AU - Nathan, Sriram
AU - Kar, Biswajit
AU - Marmagkiolis, Konstantinos
AU - Lopez-Mattei, Juan
AU - Patel, Jay
AU - Gregoric, Igor
AU - Yao, James
AU - Iliescu, Cezar A.
N1 - Publisher Copyright:
Copyright © 2023 Honan, Hassan, Deswal, Herrmann, Song, Monlezun, Halperin, Mahvash, Dasari, Koutroumpakis, Akay, Balanescu, de Armas, Patel, Nathan, Kar, Marmagkiolis, Lopez-Mattei, Patel, Gregoric, Yao and Iliescu.
PY - 2023/1/12
Y1 - 2023/1/12
N2 - Background: Carcinoid heart disease (CnHD) is a frequent cause of morbidity and mortality in patients with neuroendocrine tumors and carcinoid syndrome. Although valve replacement surgery appears to decrease all-cause mortality in patients with advanced CnHD, few studies have investigated the outcomes of patients after valve replacement. Methods: We conducted a multi-institution retrospective registry of patients who received both tricuspid and pulmonic bioprosthetic valve (TV/PV) replacements for advanced CnHD from November 2005 to March 2021. Patients were followed post-operatively with echocardiographic studies every 3 months. Carcinoid valvular heart disease scores were used to monitor valve degeneration. Neuroendocrine tumor treatment, their administration times, and associations with echocardiographic findings were recorded. Results: Of 87 patients with CnHD, 22 patients underwent simultaneous surgical TV and PV replacement. In 6 patients (27.3%), increased PV Vmax was the first echocardiographic manifestation of valve degeneration in the setting of occult neurohormonal release. Post-operative telotristat ethyl and peptide receptor radionuclide therapy appeared to stabilize PV Vmax. The PV Vmax showed consistent elevation in the entire patient population when compared to baseline, while bioprosthetic TV echocardiographic parameters were relatively unchanged throughout. Post-operative warfarin therapy did not affect the rate of PV degeneration, and no major bleeding was recorded during or after post-operative anticoagulation therapy. Conclusion: Bioprosthetic valve degeneration is common in CnHD. Monitoring with echocardiographic studies every 3 months, focusing on PV velocities, could identify patients with occult disease that very likely promotes valve degeneration. Novel neuroendocrine tumor therapies may have a beneficial impact on valve degeneration.
AB - Background: Carcinoid heart disease (CnHD) is a frequent cause of morbidity and mortality in patients with neuroendocrine tumors and carcinoid syndrome. Although valve replacement surgery appears to decrease all-cause mortality in patients with advanced CnHD, few studies have investigated the outcomes of patients after valve replacement. Methods: We conducted a multi-institution retrospective registry of patients who received both tricuspid and pulmonic bioprosthetic valve (TV/PV) replacements for advanced CnHD from November 2005 to March 2021. Patients were followed post-operatively with echocardiographic studies every 3 months. Carcinoid valvular heart disease scores were used to monitor valve degeneration. Neuroendocrine tumor treatment, their administration times, and associations with echocardiographic findings were recorded. Results: Of 87 patients with CnHD, 22 patients underwent simultaneous surgical TV and PV replacement. In 6 patients (27.3%), increased PV Vmax was the first echocardiographic manifestation of valve degeneration in the setting of occult neurohormonal release. Post-operative telotristat ethyl and peptide receptor radionuclide therapy appeared to stabilize PV Vmax. The PV Vmax showed consistent elevation in the entire patient population when compared to baseline, while bioprosthetic TV echocardiographic parameters were relatively unchanged throughout. Post-operative warfarin therapy did not affect the rate of PV degeneration, and no major bleeding was recorded during or after post-operative anticoagulation therapy. Conclusion: Bioprosthetic valve degeneration is common in CnHD. Monitoring with echocardiographic studies every 3 months, focusing on PV velocities, could identify patients with occult disease that very likely promotes valve degeneration. Novel neuroendocrine tumor therapies may have a beneficial impact on valve degeneration.
KW - carcinoid heart disease
KW - cardio-oncology
KW - peptide receptor radionuclide therapy (PRRT)
KW - pulmonary valve
KW - pulmonary valve (stenosis) (insufficiency)
KW - telotristat ethyl
KW - tricuspid valve (TV)
KW - tricuspid valve repair
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U2 - 10.3389/fcvm.2022.1072890
DO - 10.3389/fcvm.2022.1072890
M3 - Article
AN - SCOPUS:85147096091
SN - 2297-055X
VL - 9
JO - Frontiers in Cardiovascular Medicine
JF - Frontiers in Cardiovascular Medicine
M1 - 1072890
ER -