Results:

Tricuspid valve replacement was undertaken in all patients, and a bioprosthesis was used in 159 patients. A concurrent pulmonary valve operation was performed in 157, which included 50 pulmonary valvectomies, and 107 pulmonary valve replacements. Mitral valve repair was required in five patients and replacement in 16, and aortic valve procedures in 15. The mean time from diagnosis of carcinoid tumor to valve operation was 4.7 ± 6 years and 125 patients were New York Heart Association (NYHA) functional class III or IV. Octriatide therapy prior to surgery was used in 184 patients (94%). Severe tricuspid regurgitation was present in all. Over the 27-year period, operative mortality was 10%, but declined steadily for the era before 1990 to the most recent decade of experience. For the 97 patients operated since 2000, there were eight perioperative deaths (6%). One-, 5-, and 10-year survival was 69%, 35%, and 24%, respectively. Multivariable analysis identified older age, preoperative chemotherapy, and preoperative tobacco use as the only significant predictors of mortality during follow-up. On multivariable analysis, only era of operation and need for intravenous loop diuretics predicted perioperative mortality. Over the follow-up period, 17 patients required reoperation, including replacement of tricuspid bioprosthesis in eight patients. In only one instance was the indication for replacement carcinoid involvement of a bioprosthetic valve, and in others, valve thrombosis was the indication. For patients in NYHA class III or IV, 69 patients (75%) had symptomatic improvement and 118 (76%) were NYHA class I or II at follow-up. Long-term survival was not different between the patients operated on with severe symptoms versus those who were operated on in a presymptomatic state.