Overall survival based on risk prediction scores after cardiac surgery in carcinoid heart disease

Patients with neuroendocrine tumors commonly develop carcinoid heart disease (CaHD), which affects predominantly right-sided valves (mainly tricuspid). 1 CaHD carries risks of mortality and morbidity, with a 3-year survival of 50% for untreated patients with severe cardiac symptoms.Surgical valve replacement carries some risk, and which patients benefit most from surgical intervention is unclear.Hence, in the present study, we aimed to evaluate survival after cardiac surgery based on available risk prediction scores and to identify patients who benefit most from surgical intervention.Given that most CaHD patients have tricuspid regurgitation (TR), 2 we retrospectively applied the Tricuspid Regurgitation Impact on Outcomes (TRIO) 3 score and the TRI-SCORE 4 to risk-stratify patients and to estimate the overall mortality.The TRIO score proposed to riskstratify patients with TR is based on 8 parameters: age, sex, congestive heart failure (CHF), chronic lung disease, heart rate, creatinine, aspartate transaminase, and presence of severe TR.The TRI-SCORE was developed to predict in-hospital mortality after isolated tricuspid valve surgery and comprises 13 variables: age, sex, New York Heart Association class, right-sided CHF signs, prior left valvular intervention, pacemaker/defibrillator, atrial fibrillation/ flutter, furosemide dose, glomerular filtration rate, total bilirubin, left ventricular ejection fraction (LVEF), right ventricular (RV) dysfunction, and TR mechanism.The TRIO score was developed across all TR groups, including CaHD patients.Survival from the time of surgical intervention was evaluated using Kaplan-Meier (KM) and Cox regression methods based on the Social Security Death Index.Statistical analyses were performed using BlueSky v10.2.0 (BlueSky Statistics).Using the Mayo Clinic cardiac surgical database, we included patients with (1) an International Classification of Diseases Ninth/10th Revision diagnosis of neuroendocrine tumor, (2) echocardiographic evidence of CaHD, and (3) surgical intervention for CaHD at Mayo Clinic between 2001 and 2019.The study was approved by the Institutional Review Board (ID 21-013364; approved January 18, 2022), and all included patients provided informed consent.Comprehensive echocardiography was performed based on guidelines. 5he study cohort of 160 patients included 87 females (52%) and had a median age of 63.8 years (range, 56.0-69.6 years).The prevalence of CHF was 36.3% (58 patients); 107 patients (66.9%) were on a diuretic, with a median dose of furosemide (or equivalent) of 20 mg (range, 0-40 mg).On echocardiography, moderate or greater right atrial or RV enlargement was present in