Introduction: Carcinoid heart disease (CHD) is a rare complication of neuroendocrine tumours (NETs) and carcinoid syndrome (CS). Approximately one in five patients with CS go on to develop CHD, which primarily affects the right side of the heart; leading to thickened, retracted, immobile and regurgitant cardiac valves that ultimately result in right ventricular (RV) dilatation and dysfunction 1 . Patients are referred for valve replacement if they have severe symptomatic disease or evidence of RV failure and a post-operative life expectancy of ≥12 months2 . However, not all these patients go on to have definitive cardiothoracic surgery.
Aim: We aim to identify the reasons patients who met the criteria for valve surgery were not operated on at our centre.
Methods: We reviewed the available electronic medical records of all patients diagnosed with CHD at our tertiary centre, collecting data on demographics and documented rationale for not undergoing surgery.
Results: We identified 26 patients diagnosed with CHD from 2013 to present day (mean age 69 years, 50% female). The most common reasons patients did not undergo surgery were due to active weight loss/sarcopenia (37%) and frailty (33%). Additional reasons included: advanced age (9%), NET progression (9%), patient choice (5%) and others (7%) - including infection, deranged liver profile and symptomatic patent foramen ovale not amenable to percutaneous closure.
Conclusion: In our cohort weight loss and sarcopenia were the most common reasons patients were deemed unfit for cardiac surgery. This highlights the importance of prompt multidisciplinary team input including dietician review in this patient group.
References: 1. Pellikka, P.A.; Tajik, A.J.; Khandheria, B.K.; Seward, J.B.; Callahan, J.A.; Pitot, H.C.; Kvols, L.K. Carcinoid heart disease. Clinical and echocardiographic spectrum in 74 patients. Circulation 1993, 87, 11881196. 2. Davar, J.; Connolly, H.M.; Caplin, M.E.; Pavel, M.; Zacks, J.; Bhattacharyya, S.; Cuthbertson, D.J.; Dobson, R.; Grozinsky-Glasberg, S.; Steeds, R.P.; et al. Diagnosing and Managing Carcinoid Heart Disease in Patients With Neuroendocrine Tumors: An Expert Statement. J. Am. Coll. Cardiol. 2017, 69, 12881304.