BACKGROUND: Symptoms and survival of patients with carcinoid syndrome have 
improved, but development of carcinoid heart disease (CaHD) continues to 
decrease survival.
OBJECTIVES: This study aimed to analyze patient outcomes after valve surgery for 
CaHD during a 27-year period at 1 institution to determine early and late 
outcomes and opportunities for improved patient care.
METHODS: We retrospectively studied the short-term and long-term outcomes of all 
consecutive patients with CaHD who underwent valve replacement at our 
institution between 1985 and 2012.
RESULTS: The records of 195 patients with CaHD were analyzed. Pre-operative New 
York Heart Association class was III or IV in 125 of 178 patients (70%). All had 
tricuspid valve replacement (159 bioprostheses, 36 mechanical), and 
157 underwent a pulmonary valve operation. Other concomitant operations included 
mitral valve procedure (11%), aortic valve procedure (9%), patent foramen ovale 
or atrial septal defect closure (23%), cardiac metastasectomies or biopsy (4%), 
and simultaneous coronary artery bypass (11%). There were 20 perioperative 
deaths (10%); after 2000, perioperative mortality was 6%. Survival rates (95% 
confidence intervals) at 1, 5, and 10 years were 69% (63% to 76%), 35% (28% to 
43%), and 24% (18% to 32%), respectively. Overall mortality was associated with 
older age, cytotoxic chemotherapy, and tobacco use; 75% of survivors had 
symptomatic improvement at follow-up. Presymptomatic valve operation was not 
associated with late survival benefit.
CONCLUSIONS: Operative mortality associated with valve replacement surgery for 
CaHD has decreased. Symptomatic and survival benefit is noted in most patients 
when CaHD is managed by an experienced multidisciplinary team.