Severe carcinoid heart disease (CaHD) may require bioprosthetic valve (BPV) replacement. Lutetium-177 (Lu-177) DOTATATE is increasingly utilized in patients with neuroendocrine tumors (NETs); however, its effect on BPVs remains unknown. A retrospective review of patients with CaHD who underwent BPV replacement at three tertiary centers in the United States was conducted. Patients were stratified by Lu-177 DOTATATE therapy with a propensity-matched non-exposed cohort. BPV degeneration and mortality were compared. Of 183 patients with CaHD and BPV replacement (median age 62.9 years, 50.8% male), 27 received Lu-177 DOTATATE (16 postoperatively, 11 preoperatively). BPVs treated with Lu-177 DOTATATE postoperatively demonstrated increased BPV degeneration (HR 4.42, 95%CI 3.29–5.93, p < 0.001). BPVs in patients preoperatively exposed to Lu-177 DOTATATE showed no difference in degeneration. There was no difference in mortality in those treated or not treated with Lu-177 DOTATATE. Our findings suggest an association between postoperative Lu-177 DOTATATE and increased BPV degeneration in CaHD patients. Where feasible, therapy prior to valve replacement should be considered.
Scalia et al. (2026) studied this question.