Surgical treatment of valvular heart disease in patients with acromegaly

Background and aim of the study: Acromegaly is associated with heart diseas e in one-third of patients, and diastolic dysfunction may precede global sy stolic dysfunction. Patients with acromegalic heart disease may have valvul ar disease, but the role of surgery in such patients has not been establish ed. The purpose of this study was to document the outcome of surgery in a s eries of these patients from one institution. Methods: Among 951 patients with the diagnosis of acromegaly seen at our in stitution since 1972, 10 (eight men, two women) have undergone operation fo r valvular heart disease. Average patient age was 62.2 +/- 11.5 years; aver age body weight was 84 +/- 13 kg; average height was 178 +/- 12 cm. The mea n duration of acromegaly was 15.2 +/- 12.7 years. At the time of heart surg ery, seven patients had active disease, defined by elevation of growth horm one levels, while three had inactive disease. Treatment of pituitary adenom as before valvular surgery included surgical resection in three patients an d external-beam radiation treatment in four. The preoperative ejection frac tion was 42 +/- 19% (range: 20% to 66%). Valve lesions included aortic sten osis in four patients, aortic regurgitation in four, and mitral regurgitati on in three (one patient had double valve disease). Results: Valve replacement was performed in all patients with aortic diseas e (two bioprostheses, six mechanical), and three patients with mitral regur gitation had repair. Concomitant procedures performed in seven patients inc luded coronary bypass (two), left ventricular aneurysmectomy (two), and lig ation of the left atrial appendage, septal myectomy and defibrillator inser tion (one each). Early complications included endocarditis, low cardiac out put and arrhythmia in one patient each. There were no perioperative deaths. One patient underwent reoperation ten years later for a perivalvular leak. Conclusion: Valvular surgery can be performed safely in acromegalic patient s, even those with active endocrinopathy.