Cardiac valvular surgery and history of anorectic drug intake: A retrospective study of a large population of benfluorex-exposed patients

Anorectic drugs are overlooked as a cause of valvular heart disease (VHD). Aim. - To describe the characteristics of a large population of patients with severe VHD whounderwent cardiac surgery and had a history of benfluorex intake. Methods. - Retrospective observational and cross-sectional study of patients from a largeFrench database (Office National d'Indemnisation des Accidents Medicaux). Clinical, echocardiographic, surgical and pathology findings were comprehensively collected from medical files. Results. - From a chart review of 9584 subjects, 1031 patients with VHD underwent cardiacsurgery; 453 surgical patients were excluded because of VHD obviously unrelated to benfluorexexposure, six because of missing data and eight declined to participate. The final study population comprised 564 patients who had surgery between 1987 and 2019. Median age was 58( interquartile range 50-65) years; 85% were female. Median duration of preoperative benfluorex exposure was 5.8 (3.3-10) years. Most patients had aortic and mitral valve disease. Pureor predominant aortic and/or mitral regurgitation were found in 84% of patients (n = 471), andaortic or mitral stenosis (pure or combined with regurgitation) in 12% (n = 67) and 15% (n = 84), respectively. Overall, 403 aortic, 402 mitral and 64 tricuspid valve surgical procedures werecollected. Aortic and mitral valves were found to be thickened, rigid and/or restrictive in mostcases; restrictive tricuspid valve disease was seldom documented. Pathology was available inhalf of the population (276 patients); valvular fibrosis suggestive of drug-induced VHD was foundin 222 patients, including 146 with expert examination. Mixed VHD aetiologies were discussedin 107 patients, including 54 with available pathology. Conclusions. - Drug-induced VHD features are miscellaneous, including well-known restrictivevalvular regurgitation, but also stenosis or combined regurgitation and stenosis. Besides a history of drug taking, thorough echocardiography and comprehensive surgical reports, pathologyis key in the diagnostic procedure. (c) 2022 Elsevier Masson SAS. All rights reserved.