The Role of Coronary Catheterization with Angiography in Surgically Managed Infectious Endocarditis

Area of Science:

• Cardiology
• Cardiac Surgery
• Infectious Diseases

Background:

• Infectious endocarditis often necessitates surgical valve replacement.
• Coronary angiography is frequently performed preoperatively, but its clinical necessity and impact on surgical decisions are not well-established.

Purpose of the Study:

• To evaluate the frequency with which coronary angiography influences surgical management in patients undergoing valve replacement for infectious endocarditis.
• To assess the impact of preoperative coronary angiography on 30-day mortality in this patient population.

Main Methods:

• Retrospective review of 598 patients with surgically managed endocarditis from a tertiary care center (April 2011 - December 2018).
• Data collected included coronary artery disease risk factors, performance of coronary angiography, and concurrent coronary artery bypass grafting.
• Comparison of outcomes between patients who underwent coronary angiography and those who did not.

Main Results:

• 430 patients (72%) received coronary angiography; 168 (28%) did not.
• Coronary artery bypass grafting was performed in 9% of patients based on angiography findings.
• No significant difference in 30-day mortality was observed between the angiography and no-angiography groups (2.6% vs 2.4%, P=0.89).

Conclusions:

• Preoperative left heart catheterization with coronary angiography is performed in most patients with infectious endocarditis undergoing valve surgery.
• Coronary angiography findings lead to coronary artery bypass grafting in a minority of these patients.
• The routine use of coronary angiography prior to valve surgery in infectious endocarditis does not appear to significantly alter short-term mortality.