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Updated: Feb 4, 2026
Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Incidence and outcomes of early percutaneous coronary intervention after isolated valve surgery
Fahad Alqahtani1, Khaled Ziada2, Charanjit S Rihal3
1Department of Medicine, Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia.
Insights
Early percutaneous coronary intervention (PCI) after heart valve surgery is uncommon but significantly increases in-hospital mortality and complications. Age, robotic surgery, and kidney failure predict the need for PCI.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Coronary ischemia requiring percutaneous coronary intervention (PCI) is a rare complication after isolated valve surgery.
- The incidence, predictors, and outcomes of early PCI following valve surgery are not well-defined.
Purpose of the Study:
- To assess the incidence, predictors, and outcomes of early PCI after isolated aortic valve replacement (AVR) or mitral valve repair/replacement (MVr/MVR).
Main Methods:
- Analysis of the National Inpatient Sample (NIS) database from 2003-2014.
- Comparison of patients who underwent early PCI versus those who did not.
- Primary endpoint: in-hospital mortality; Secondary endpoints: complications, length-of-stay, cost.
Main Results:
- 0.8% of 135,611 patients required early PCI.
- Early PCI was associated with significantly higher in-hospital mortality across AVR, MVR, and MVr groups (P < 0.001).
- PCI patients experienced higher rates of stroke, acute kidney injury, infections, longer hospital stays, and increased costs. Age, robotic surgery, and chronic renal failure predicted PCI need.
Conclusions:
- Early PCI after isolated valve surgery is infrequent but linked to significant morbidity, mortality, and cost.
- Further research is needed to identify preventable causes and optimize management strategies for this complication.
Background:
Coronary ischemia requiring early percutaneous coronary intervention (PCI) is a rare but serious complication of isolated valve surgery. We sought of assess the incidence, predictors and outcomes of early PCI after isolated valve surgery using the national inpatient sample.
Methods:
Patients who underwent isolated aortic valve replacement (AVR), isolated mitral valve repair (MVr) or replacement (MVR) between 2003 and 2014 were identified. Patients who had early postoperative PCI were compared with patients who did not require PCI. Primary end point was in-hospital mortality. Secondary endpoints were complications, length-of-stay and cost.
Results:
Among the 135,611 included patients, 1,074 (0.8%) underwent PCI prior to discharge. Unadjusted in-hospital mortality was higher in patients requiring early PCI following AVR (11.2 vs. 3.1%), MVR (24.1 vs. 5.5%), and MVr (22.4 vs. 2.5%) (P < 0.001) compared with patients not requiring PCI. Postoperative PCI remained independently associated with higher mortality after adjusting for demographics, comorbidities and hospital characteristics (adjusted OR [aOR] = 3.74, 95%CI 2.70-5.17 for AVR, aOR = 6.10, 95%CI 4.53-8.23 for MVR, and aOR = 9.90, 95%CI 7.22-13.58 for MVr). Patients undergoing PCI had higher incidences of stroke, acute kidney injury, infectious complications, higher hospital charges, and longer hospitalizations. Age, robotic-assisted surgery, and chronic renal failure were independent predictors of needing early postoperative PCI.
Conclusions:
Early PCI after isolated aortic or mitral valve surgery is rare but is associated with substantial in-hospital morbidity, mortality, and cost. Further studies are needed to identify preventable causes, and optimal management strategies of this serious complication.
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