Quadruple-valve replacement in patients with carcinoid heart disease: A 24-year experience

Objectives Replacement of all 4 cardiac valves for carcinoid heart disease (CaHD) is rare. The purpose of this study was to evaluate the prevalence and outcomes after concomitant quadruple-valve replacement for CaHD. Methods Between May 1999 and March 2022, 13 consecutive patients with CaHD underwent concomitant quadruple-valve replacement at our institution. We reviewed preoperative characteristics, intraoperative management, and operative outcomes using a prospectively maintained database. Descriptive statistics were used to assess patient characteristics and outcomes. Results The median age was 61 years, and 9 patients (69.2%) were women. The majority (10/13) were in New York Heart Association (NYHA) class III or IV. All patients had moderate or severe valve regurgitation of all 4 valves. The median right ventricular systolic pressure was 54 mm Hg, and the left ventricular ejection fraction was 58%. All patients had liver metastasis, and 3 had bone metastasis. Operative mortality occurred in 2 patients (15.4%). The median length of stay was 9.0 days (interquartile range, 7.0-14.0 days). There was a nonsignificant improvement in NYHA class from an average of III preoperatively to II at 3 months postoperatively ( P = .063), with no patients (0/8) in NYHA class IV. Median survival was 7.2 months, with the number of patients alive at 12, 24, and 36 months' survival being 7 (53.9%), 6 (46.2%), and 4 (30.8%), respectively. Two patients (15.4%) are currently alive, with 3.5 and 6.4 years of follow-up, respectively. Conclusions Quadruple-valve replacement in patients with carcinoid heart disease is associated with elevated operative mortality and limited life expectancy in most patients. Selection of these patients for surgery should be done carefully.