Effect of Valvular Surgery in Carcinoid Heart Disease: An Observational Cohort Study
Effect of Valvular Surgery in Carcinoid Heart Disease: An Observational Cohort Study
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DOI：
10.1210/jc.2015-3295
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发表时间：
2016-01-01
影响因子：
5.8
通讯作者：
Steeds, R. P.
中科院分区：
文献类型：
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作者：
Edwards, N. C.;Yuan, M.;Steeds, R. P.
背景：类癌性心脏病（NET-CHD）与症状受限运动能力的发展以及高发病率和死亡率相关。目的：本研究旨在确定手术后的生存率、心功能和功能等级。设计、环境和患者：这是一项2005年至2015年在伯明翰伊丽莎白女王医院欧洲神经内分泌肿瘤卓越中心进行的回顾性观察性队列研究。英国由62名连续患者组成，转介到net心脏病学服务。干预措施：在转诊时使用经胸超声心动图（含生理盐水造影剂）和经食管超声心动图对受试者进行评估，77%确诊为NET-CHD的患者接受了心血管磁共振成像。伴有严重瓣膜功能障碍的有症状患者在NET病情稳定的情况下接受手术治疗。主要观察指标：测量经内科和外科治疗的NET-CHD患者的生存率。结果：47/62例患者被诊断为NET-CHD。所有受试者中有32例（68%）接受了生物瓣膜置换术；三尖瓣，n = 31；肺组，n = 30；二尖瓣，n = 3；主动脉，n = 3。4例患者行冠状动脉旁路移植术。术后早期死亡4例（13%）。术后1年和2年生存率分别为75%和69%，而未手术患者的存活率分别为45%和15%。术后，功能分级得到改善（纽约心脏协会分级[NYHA]前，2.6 [0.5]vs NYHA后，1.7 [1.1]），P < 0.05，右心室（RV）体积减小(136 ml/m(2) [7] vs 71 ml/m(2) [7]；P < 0.01)，右心室射血分数保持不变（61% +/- 9 vs 55% +/- 10; P = 0.26）。结论：与不进行手术的患者相比，瓣膜手术改善了功能等级，导致右心室反向重构，并提高了2年生存率。这些数据强调了NET临床医生、心脏科和心胸外科团队之间密切合作的重要性。早期转诊可以改善功能能力，但需要更多的研究来确定合适的候选人的选择，并需要随机数据来确定手术对预后的影响。
Context: Carcinoid heart disease (NET-CHD) is associated with the development of symptom-limited exercise capacity and high rates of morbidity and mortality.Objective: This study sought to determine the survival, cardiac function, and functional class following surgery.Design and Setting, and Patients: This was a retrospective observational cohort study between 2005 and 2015 at a European Centre of Excellence for Neuroendocrine Tumours, Queen Elizabeth Hospital Birmingham. England consisting of 62 consecutive patients referred to the NET-Cardiology Service.Interventions: Subjects were assessed at referral using transthoracic echocardiography (with saline contrast) and transesophageal echocardiography, and 77% with confirmed NET-CHD underwent cardiovascular magnetic resonance imaging. Symptomatic patients with concomitant severe valvular dysfunction were referred for surgery with stable NET disease.Main Outcome Measure: Survival of patients with proven NET-CHD following medical and surgical treatments was measure.Results: In total, 47/62 patients were diagnosed with NET-CHD. Thirty-two patients (68%) underwent surgery with bioprosthetic valve replacements in all subjects; tricuspid, n = 31; pulmonary, n = 30; mitral, n = 3; and aortic, n = 3. Four patients underwent concomitant coronary artery bypass grafting. There were 4 (13%) early post-operative deaths. One-and 2-y survival rates after surgery were 75 and 69% compared with 45 and 15% in un-operated patients. Post-operatively, functional class was improved (pre-New York Heart Association Classification [NYHA], 2.6 [0.5] vs post-NYHA, 1.7 [1.1]), P < .05, right-ventricular (RV) size was reduced (136 ml/m(2) [25] vs 71 ml/m(2) [7]; P < .01) with preserved RV ejection fraction (61% +/- 9 vs 55% +/- 10; P = .26).Conclusion: Valve surgery improved functional class and resulted in RV reverse remodelling with improved survival rates at 2 y compared with those not proceeding to operation. These data highlight the importance of close collaboration between NET clinicians, cardiology, and cardiothoracic surgery teams. Early referral can improve functional capacity but more research is needed to define the selection of appropriate candidates and randomized data are needed to define the effect of surgery on prognosis.