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The prevalence, operations, and outcomes of carcinoid heart disease

      Highlights

      • Carcinoid heart disease (CHD) incidence was 14% of patients with metastases and 25% of patients with carcinoid syndrome.
      • CHD patients with valve replacement operations had a 0% operative mortality and yielded longer-term survival rates.
      • Hepatic cytoreduction may reduce the risk of subsequent CHD.
      • Our data do not support a protective effect of octreotide to prevent new or recurrent CHD.

      Abstract

      Background

      Carcinoid heart disease (CHD) is a sequela of carcinoid liver metastases (LM). The true prevalence of CHD is unknown due to infrequent screening by transthoracic echocardiography (TTE). Octreotide is believed to protect against new and recurrent CHD, but supporting data are scant. This study determined CHD prevalence and outcomes in patients screened by TTE and treated with octreotide.

      Methods

      Records of carcinoid patients from 2001 to 2021 were reviewed. Survival was estimated by Kaplan-Meyer curves and compared by log-rank.

      Results

      Among 282 patients screened by TTE, overall survival was lower in CHD (n = 40) versus non-CHD (n = 242) patients (p < 0.001). Despite octreotide therapy, 21 patients developed CHD. Among patients with inoperable LM, survival was lower in CHD patients without valve replacement (VR) (p < 0.001), but similar between CHD patients with VR and non-CHD patients. CHD patients with VR and hepatic cytoreduction had survival similar to CHD patients without VR.

      Conclusion

      VR improves survival in CHD patients with inoperable LM. Hepatic cytoreduction after VR should be reserved for carefully selected cases. Our data do not support a protective effect of octreotide.
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