Transcatheter valve replacement in carcinoid heart disease: A potential change of paradigm

OBJECTIVES To evaluate the feasibility and early clinical outcomes of transcatheter valve replacement in high-surgical-risk patients with carcinoid heart disease. Material and methods This study included 15 procedures performed in 9 patients with symptomatic carcinoid heart disease between 2021 and 2025. Valve involvement included the pulmonary valve in 9 cases, the tricuspid valve in 5 cases, and the aortic valve in 1 case. Valve selection (SAPIEN 3, TOPAZ, LUX) was individualized according to anatomical considerations. All 9 patients received intravenous periprocedural octreotide. Outcomes included procedural success, NYHA class, and echocardiographic evaluation of valve and ventricular function. RESULTS Single-valve replacement was performed in 4 patients (2 pulmonary and 2 tricuspid). Double-valve replacement involving the pulmonary and tricuspid valves was performed in 4 patients, and 1 patient underwent triple-valve replacement (aortic, pulmonary, and tricuspid). One high-risk patient required conversion after a tricuspid procedure but ultimately recovered after a prolonged hospital stay. At a median follow-up of 9.9 months (IQR 3.5), all patients showed clinical improvement. One patient developed a transient tricuspid paravalvular thrombus without dysfunction or clinical consequence. Echocardiography demonstrated a reduction in right ventricular diameter. No case of endocarditis was observed. One patient died 4 months post-procedure from tumour progression. CONCLUSIONS This first series of transcatheter valve replacements in carcinoid heart disease suggests that a complete percutaneous approach is feasible, safe, and potentially beneficial. These early results warrant confirmation in larger cohorts with longer follow-up and may represent a paradigm shift in the management of carcinoid valve disease.