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Early and Late Outcomes of Surgical Treatment in Carcinoid Heart Disease.
- Source :
-
Journal of the American College of Cardiology (JACC) . Nov2015, Vol. 66 Issue 20, p2189-2196. 8p. - Publication Year :
- 2015
-
Abstract
- <bold>Background: </bold>Symptoms and survival of patients with carcinoid syndrome have improved, but development of carcinoid heart disease (CaHD) continues to decrease survival.<bold>Objectives: </bold>This study aimed to analyze patient outcomes after valve surgery for CaHD during a 27-year period at 1 institution to determine early and late outcomes and opportunities for improved patient care.<bold>Methods: </bold>We retrospectively studied the short-term and long-term outcomes of all consecutive patients with CaHD who underwent valve replacement at our institution between 1985 and 2012.<bold>Results: </bold>The records of 195 patients with CaHD were analyzed. Pre-operative New York Heart Association class was III or IV in 125 of 178 patients (70%). All had tricuspid valve replacement (159 bioprostheses, 36 mechanical), and 157 underwent a pulmonary valve operation. Other concomitant operations included mitral valve procedure (11%), aortic valve procedure (9%), patent foramen ovale or atrial septal defect closure (23%), cardiac metastasectomies or biopsy (4%), and simultaneous coronary artery bypass (11%). There were 20 perioperative deaths (10%); after 2000, perioperative mortality was 6%. Survival rates (95% confidence intervals) at 1, 5, and 10 years were 69% (63% to 76%), 35% (28% to 43%), and 24% (18% to 32%), respectively. Overall mortality was associated with older age, cytotoxic chemotherapy, and tobacco use; 75% of survivors had symptomatic improvement at follow-up. Presymptomatic valve operation was not associated with late survival benefit.<bold>Conclusions: </bold>Operative mortality associated with valve replacement surgery for CaHD has decreased. Symptomatic and survival benefit is noted in most patients when CaHD is managed by an experienced multidisciplinary team. [ABSTRACT FROM AUTHOR]
- Subjects :
- *HEALTH outcome assessment
*CARCINOID heart disease
*HEART diseases
*THERAPEUTICS
*CARDIAC surgery
*MITRAL valve surgery
*PULMONARY valve
*SURVIVAL analysis (Biometry)
*SURGERY
*PROSTHETIC heart valves
*HEART valve diseases
*LONGITUDINAL method
*SURGICAL complications
*SURVIVAL
*TREATMENT effectiveness
*RETROSPECTIVE studies
AORTIC valve surgery
Subjects
Details
- Language :
- English
- ISSN :
- 07351097
- Volume :
- 66
- Issue :
- 20
- Database :
- Academic Search Index
- Journal :
- Journal of the American College of Cardiology (JACC)
- Publication Type :
- Academic Journal
- Accession number :
- 110680263
- Full Text :
- https://doi.org/10.1016/j.jacc.2015.09.014