18 Characteristics and outcomes of patients with carcinoid heart disease - a single-centre experience

Background Carcinoid tumours are rare neoplasms which affects around 2 in 100,000 people annually. Around 60% of these patients have cardiac involvement, most commonly in the form of right sided valve disease and is associated with very poor long-term prognosis. Surgical correction of carcinoid valve disease is the only definitive way to improve symptoms and prognosis. Aims The objective of this study is to evaluate the characteristics of patients within a single tertiary centre which can identify parameters that can predict outcomes in patients with carcinoid heart disease undergoing assessment for surgery. Methods A retrospective analysis of the electronic patient record of patients with carcinoid heart disease referred to Liverpool Heart and Chest hospital for consideration of valve surgery from 2015 to 2023 was carried out. Data including demographics, medical and drug history, echocardiographic parameters, blood biomarkers, surgical procedure and mortality outcomes were collected. Patients with less than 1 year follow up data were excluded. The primary outcome of interest was 1 year mortality. Analyses were performed with Stata version 15.1 (StataCorp, College Station, TX, USA). Results 24 patients were included in the analysis. 7 patients were deemed not suitable for surgery, with the majority (6) due to frailty and 1 due to decompensated liver failure. 1 year mortality was 57% in this cohort, with 100% 3-year mortality. 17 patients had surgery in which 7 had TVR and PVR, 4 had isolated TVR, 3 had TVR and PVR with left sided valve replacement, 2 had TVR and PVR with CABG and 1 had TVR and PVR with LAD-PA fistula closure. 7 patients died within a year and 8 within 3 years of surgery. The baseline characteristics are as shown in table 1. Mortality risk estimated by EuroSCORE II is lower, although not significantly, in survivors compared to non-survivors. Discussion Our data has shown the poor prognosis in patients with significant carcinoid heart disease, with 100% mortality in 3 years in patients without surgical intervention. Bedside definition of frailty appears to be predictive of prognosis in this group of patients but would benefit from being more quantifiable. Even with surgical intervention, 3-year mortality remains at 47%. More data would be required to identify potential prognostic markers in this high-risk group of patients which could help select patients who would benefit most from surgical intervention. Conflict of Interest None