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• W4280641456 abstract "BackgroundCarcinoid heart disease (CnHD) is a frequent cause of morbidity and mortality in patients with carcinoid neuroendocrine tumors. 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.MethodsWe conducted a multi-institution historically prospective review of patients who received both tricuspid and pulmonic bioprosthetic valve (TV/PV) replacements for advanced CnHD from November 2005 to March 2021. After surgery, patients were followed with echocardiographic studies every 3 months. Carcinoid valvular heart disease (CVHD) scores were used to monitor valve degeneration. Neuroendocrine tumor treatments and their administration times were recorded and the extent to which they were associated with echocardiographic findings was determined.ResultsFrom November 2005 through March 2021, out of 87 patients with carcinoid heart disease, 22 patients underwent simultaneous surgical TV and PV replacement for CnHD. In 6 patients (27.3%), increased velocity across the bioprosthetic PV was the first recorded echocardiographic manifestation of valve degeneration in the setting of stable tumor size/burden and in the absence of clinical signs of breakthrough carcinoid syndrome (flushing, diarrhea, anxiety) leading to novel carcinoid treatments. The PVVmax was the most sensitive CVHD parameter for tracking PV degeneration. The use of telotristat ethyl and peptide receptor radionuclide therapy appeared to stabilize valve degeneration. Bioprosthetic tricuspid valves’ echocardiographic parameters were relatively unchanged throughout the study. Postoperative warfarin therapy did not slow the rate of PV degeneration, and no major bleeding was recorded during or after postoperative anticoagulation therapy.ConclusionsIn CnHD patients with stable tumor burden, bioprosthetic valve degeneration is common. Close monitoring with echocardiographic studies every 3 months, with focus on PV velocities, could identify patients with occult disease that very likely promotes valve degeneration. Novel neuroendocrine tumor therapies could have a promising impact on valve degeneration.DisclosuresK. A. Honan Nothing to disclose. S. Hassan Nothing to disclose. A. Deswal Nothing to disclose. J. Song Nothing to disclose. D. Halperin Nothing to disclose. A. Dasari Nothing to disclose. B. Akkanti Nothing to disclose. K. Marmagkiolis Nothing to disclose. I. Gregoric Nothing to disclose. M. Patel Nothing to disclose. S. Nathan Nothing to disclose. J. Yao Nothing to disclose. C. A. Iliescu Nothing to disclose. BackgroundCarcinoid heart disease (CnHD) is a frequent cause of morbidity and mortality in patients with carcinoid neuroendocrine tumors. 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. Carcinoid heart disease (CnHD) is a frequent cause of morbidity and mortality in patients with carcinoid neuroendocrine tumors. 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. MethodsWe conducted a multi-institution historically prospective review of patients who received both tricuspid and pulmonic bioprosthetic valve (TV/PV) replacements for advanced CnHD from November 2005 to March 2021. After surgery, patients were followed with echocardiographic studies every 3 months. Carcinoid valvular heart disease (CVHD) scores were used to monitor valve degeneration. Neuroendocrine tumor treatments and their administration times were recorded and the extent to which they were associated with echocardiographic findings was determined. We conducted a multi-institution historically prospective review of patients who received both tricuspid and pulmonic bioprosthetic valve (TV/PV) replacements for advanced CnHD from November 2005 to March 2021. After surgery, patients were followed with echocardiographic studies every 3 months. Carcinoid valvular heart disease (CVHD) scores were used to monitor valve degeneration. Neuroendocrine tumor treatments and their administration times were recorded and the extent to which they were associated with echocardiographic findings was determined. ResultsFrom November 2005 through March 2021, out of 87 patients with carcinoid heart disease, 22 patients underwent simultaneous surgical TV and PV replacement for CnHD. In 6 patients (27.3%), increased velocity across the bioprosthetic PV was the first recorded echocardiographic manifestation of valve degeneration in the setting of stable tumor size/burden and in the absence of clinical signs of breakthrough carcinoid syndrome (flushing, diarrhea, anxiety) leading to novel carcinoid treatments. The PVVmax was the most sensitive CVHD parameter for tracking PV degeneration. The use of telotristat ethyl and peptide receptor radionuclide therapy appeared to stabilize valve degeneration. Bioprosthetic tricuspid valves’ echocardiographic parameters were relatively unchanged throughout the study. Postoperative warfarin therapy did not slow the rate of PV degeneration, and no major bleeding was recorded during or after postoperative anticoagulation therapy. From November 2005 through March 2021, out of 87 patients with carcinoid heart disease, 22 patients underwent simultaneous surgical TV and PV replacement for CnHD. In 6 patients (27.3%), increased velocity across the bioprosthetic PV was the first recorded echocardiographic manifestation of valve degeneration in the setting of stable tumor size/burden and in the absence of clinical signs of breakthrough carcinoid syndrome (flushing, diarrhea, anxiety) leading to novel carcinoid treatments. The PVVmax was the most sensitive CVHD parameter for tracking PV degeneration. The use of telotristat ethyl and peptide receptor radionuclide therapy appeared to stabilize valve degeneration. Bioprosthetic tricuspid valves’ echocardiographic parameters were relatively unchanged throughout the study. Postoperative warfarin therapy did not slow the rate of PV degeneration, and no major bleeding was recorded during or after postoperative anticoagulation therapy. ConclusionsIn CnHD patients with stable tumor burden, bioprosthetic valve degeneration is common. Close monitoring with echocardiographic studies every 3 months, with focus on PV velocities, could identify patients with occult disease that very likely promotes valve degeneration. Novel neuroendocrine tumor therapies could have a promising impact on valve degeneration. In CnHD patients with stable tumor burden, bioprosthetic valve degeneration is common. Close monitoring with echocardiographic studies every 3 months, with focus on PV velocities, could identify patients with occult disease that very likely promotes valve degeneration. Novel neuroendocrine tumor therapies could have a promising impact on valve degeneration." @default.
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• W4280641456 title "D-43 | Bioprosthetic Valve Monitoring in Patients with Carcinoid Heart Disease" @default.
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