TITLE

Role of Hepatic Resection for Patients With Carcinoid Heart Disease

AUTHOR(S)
Bernheim, Alain M.; Connolly, Heidi M.; Rubin, Joseph; Møller, Jacob E.; Scott, Christopher G.; Nagorney, David M.; Pellikka, Patricia A.
PUB. DATE
February 2008
SOURCE
Mayo Clinic Proceedings;Feb2008, Vol. 83 Issue 2, p143
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
OBJECTIVE: To evaluate the effects of resection of hepatic carcinold metastases on progression and prognosis of carclnold heart disease. PATIENTS AND METHODS: From our database of 265 consecutive patients diagnosed as having carcinold heart disease from January 1, 1980, through December 31, 2005, we calculated survival from first diagnosis of cardiac involvement. Hepatic resection during follow-up was entered as a time-dependent covariable in a multi-variable analysis. In patients with serial echocardiograms more than 1 year apart without intervening cardiac surgery, a previously validated cardiac severity score was calculated. A score Increase that exceeded 25% was considered relevant progression. RESULTS: Hepatic resection was performed In 31 patients (12%) during follow-up. Five-year survival was significantly higher In these patients (86.5%; 95% confidence interval [CI], 73.5%-100.0%) than In patients without hepatic resection (29.0%; 95% Cl, 23.3%- 36.1%; univariable hazard ratio for hepatic resection, 0.25; 95% CI 0.12-0.53; P<.001). Hepatic resection remained strongly associated with Improved prognosis in multivariable analysis (hazard ratio, 0.31; 95% Cl, 0.14-0.66; P=.003). Among 77 patients (29%) with serial echocardiograms, 10 (13%) underwent hepatic resection during follow-up; resection was independently associated with decreased risk of cardiac progression (odds ratio, 0.29; 95% Cl, 0.06-0.75; P=.03). CONCLUSION: Despite the limitations of this retrospective nonrandomized study, our data suggest that patients with carcinold heart disease who undergo hepatic resection have decreased cardiac progression and improved prognosis. Eligible patients should be considered for hepatic surgery.
ACCESSION #
28841072

 

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