Early and Late Outcomes of Surgical Treatment in Carcinoid Heart Disease
Early and Late Outcomes of Surgical Treatment in Carcinoid Heart Disease
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DOI：
10.1016/j.jacc.2015.09.014
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发表时间：
2015-11-17
影响因子：
24
通讯作者：
Pellikka, Patricia A.
中科院分区：
文献类型：
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作者：
Connolly, Heidi M.;Schaff, Hartzell V.;Pellikka, Patricia A.
背景类癌综合征患者的症状和存活率有所改善，但类癌心脏病(CAHD)的发展持续下降。目的本研究旨在分析1个机构27年来CAHD瓣膜手术后的患者预后，以确定近期和远期结果以及改善患者护理的机会。方法回顾分析1985-2012年间所有连续接受瓣膜置换的CAHD患者的近期和长期预后。178例患者中，术前纽约心脏协会分级为III级或IV级的125例(70%)。所有患者均接受了三尖瓣置换术(159例生物瓣膜置换，36例机械瓣膜置换)，157例接受了肺动脉瓣手术。其他同期手术包括二尖瓣手术(11%)、主动脉瓣手术(9%)、卵圆孔未闭或房间隔缺损术(23%)、心脏转移术或活检(4%)、冠状动脉搭桥术(11%)。围手术期死亡20例(10%)，2000年后围手术期死亡率为6%。1年、5年和10年的生存率(95%可信区间)分别为69%(63%~76%)、35%(28%~43%)和24%(18%~32%)。总体死亡率与高龄、细胞毒性化疗和烟草使用有关；75%的幸存者在随访时症状改善。无症状瓣膜手术与远期生存效益无关。结论瓣膜置换术治疗冠心病的手术死亡率降低。当CAHD由经验丰富的多学科团队管理时，大多数患者都注意到了症状和生存方面的好处。(C)2015年，由美国心脏病学会基金会提供。
BACKGROUND Symptoms and survival of patients with carcinoid syndrome have improved, but development of carcinoid heart disease (CaHD) continues to decrease survival.OBJECTIVES This study aimed to analyze patient outcomes after valve surgery for CaHD during a 27-year period at 1 institution to determine early and late outcomes and opportunities for improved patient care.METHODS We retrospectively studied the short-term and long-term outcomes of all consecutive patients with CaHD who underwent valve replacement at our institution between 1985 and 2012.RESULTS The records of 195 patients with CaHD were analyzed. Pre-operative New York Heart Association class was III or IV in 125 of 178 patients (70%). All had tricuspid valve replacement (159 bioprostheses, 36 mechanical), and 157 underwent a pulmonary valve operation. Other concomitant operations included mitral valve procedure (11%), aortic valve procedure (9%), patent foramen ovale or atrial septal defect closure (23%), cardiac metastasectomies or biopsy (4%), and simultaneous coronary artery bypass (11%). There were 20 perioperative deaths (10%); after 2000, perioperative mortality was 6%. Survival rates (95% confidence intervals) at 1, 5, and 10 years were 69% (63% to 76%), 35% (28% to 43%), and 24% (18% to 32%), respectively. Overall mortality was associated with older age, cytotoxic chemotherapy, and tobacco use; 75% of survivors had symptomatic improvement at follow-up. Presymptomatic valve operation was not associated with late survival benefit.CONCLUSIONS Operative mortality associated with valve replacement surgery for CaHD has decreased. Symptomatic and survival benefit is noted in most patients when CaHD is managed by an experienced multidisciplinary team. (C) 2015 by the American College of Cardiology Foundation.