Document Detail

In patients with carcinoid syndrome undergoing valve replacement: will a biological valve have acceptable durability?
MedLine Citation:
PMID:  22691379     Owner:  NLM     Status:  MEDLINE    
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'In patients with carcinoid syndrome undergoing valve replacement, will a biological valve have acceptable durability?' Altogether, more than 130 papers were found using the reported search, of which 17 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The pooled data from all papers represent 51 patients with carcinoid right heart disease who underwent tricuspid valve replacement. Two 'outcomes' studies reported a 30-day postoperative mortality of 16.7-18% and 2-year survival rates of 44 and 50%, respectively. Seventeen patients were detailed in case reports. Of these 17 patients, 7 died during the follow-up period. All but one of these patients had a normal bioprosthesis at echocardiography or at post-mortem. One patient with a plaque-covered valve had a functionally normal valve. We conclude that at present, the best available evidence suggests that although 30-day mortality approaches 20%, approximately half of patients with carcinoid syndrome undergoing tricuspid valve replacement can be expected to survive 2 years. Some patients survive considerably longer than this, beyond 10 years in some cases. Importantly, at autopsy, many replacement valves have been shown to be normal, with a few patients reported as having died of cardiac causes. This should be taken as cautious evidence that biological valves have an acceptable lifespan in patients with carcinoid syndrome and that the process of valve destruction seen in carcinoid patients does not continue to a significant level in the bioprosthesis. Caveats to this include the lack of any directly comparative trial and the predominance of case reports as opposed to higher-level evidence.
Nigel Mabvuure; Alex Cumberworth; Sandip Hindocha
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Publication Detail:
Type:  Case Reports; Journal Article; Review     Date:  2012-06-12
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  15     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-21     Completed Date:  2013-01-17     Revised Date:  2013-09-03    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  467-71     Citation Subset:  IM    
Brighton and Sussex Medical School, Brighton, UK.
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MeSH Terms
Follow-Up Studies
Heart Valve Prosthesis*
Malignant Carcinoid Syndrome / complications*
Middle Aged
Prosthesis Design
Risk Factors
Tricuspid Valve / surgery*
Tricuspid Valve Insufficiency / complications,  surgery*
Comment In:
Interact Cardiovasc Thorac Surg. 2012 Sep;15(3):471-2   [PMID:  22908182 ]
Interact Cardiovasc Thorac Surg. 2012 Sep;15(3):471   [PMID:  22908181 ]

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