Outcomes after Tricuspid Valve Replacement for Carcinoid Heart Disease: A Multicenter Study

Background This study evaluates clinical and echocardiographic outcomes in patients who underwent tricuspid valve replacement (TVR) for carcinoid heart disease (CaHD) stratified to prosthesis type (biological vs mechanical). Methods All patients undergoing TVR for CaHD between 1991 and 2017 were analyzed retrospectively in four tertiary centers. Cox-proportional hazard models were used to analyze survival data and mixed-models for repeated measurements of echo and laboratory data. Results In total, 49 patients (median age: 59 [51-66], 45% male) underwent biological (n=20, 41%) or mechanical (n=29, 59%) TVR. Three (6%) patients died in-hospital and 3-year actuarial survival was 73.3±8.7% (biological) and 56.1±10.0% (mechanical) (P=0.69). During a median follow-up of 17 months, two patients with a biological prosthesis required reoperation for structural valve deterioration, while one patient with mechanical prostheses had a reoperation due to valve thrombosis. No significant differences in bleeding, thrombosis, thrombo-embolism and heart failure admissions were noted between prosthesis types. Postoperative valve regurgitation increased more in patients with biological prosthesis (p=0.022). Maximum tricuspid inflow gradient was higher in patients with biological prostheses (p=0.02), however course over time was comparable between prosthesis types (p=0.136). Conclusion Tricuspid valve surgery for CaHD can be performed with acceptable hospital mortality risk. This data shows no apparent benefit of biological valves over mechanical prosthesis or vice versa. Valve choice should be made in a multi-disciplinary team taking into account expected lifespan, planned treatment for the carcinoid syndrome and neuroendocrine tumor and patient preferences.