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Role of Concomitant Coronary Artery Bypass Grafting in Valve Surgery for Infective Endocarditis

Mahmoud Diab1, Thomas Lehmann2, Carolyn Weber3

  • 1Department of Cardiothoracic Surgery, Jena University Hospital-Friedrich Schiller University of Jena, 07747 Jena, Germany.

Journal of Clinical Medicine
|July 2, 2021
PubMed

Insights

Adding coronary artery bypass grafting (CABG) to infective endocarditis (IE) surgery for patients with coronary artery disease (CAD) increases stroke risk without improving long-term survival. Omitting CABG in IE patients with non-critical CAD may be a safe option.

Area of Science:

  • Cardiac Surgery
  • Infective Endocarditis Research
  • Coronary Artery Disease Management

Background:

  • Concomitant coronary artery bypass grafting (CABG) is often performed in infective endocarditis (IE) patients with coronary artery disease (CAD).
  • CABG can increase surgical complexity in IE patients.
  • The impact of concurrent CABG on perioperative outcomes in IE surgery requires investigation.

Purpose of the Study:

  • To evaluate the effect of performing CABG concurrently with valve surgery in patients with IE and CAD.
  • To compare perioperative and long-term outcomes between IE patients who underwent concomitant CABG and those who did not.

Main Methods:

  • Retrospective analysis of surgically treated IE patients (1994-2018) from six German cardiac surgery centers.
  • Utilized inverse probability weighting (IPW) for adjustment of baseline characteristics.
  • Employed multivariable adjustment, chi-square analysis, and Kaplan-Meier survival estimates.

Main Results:

  • Concomitant CABG was associated with a higher incidence of postoperative stroke (26% vs. 21%, p=0.003) and a trend towards increased hemodialysis (29% vs. 25%, p=0.052) after IPW adjustment.
  • Thirty-day mortality rates were comparable between groups (24% vs. 23%, p=0.370).
  • Multivariate Cox regression analysis indicated no significant association between CABG and improved long-term survival (HR: 1.00, 95% CI: 0.82-1.23, p=0.998).

Conclusions:

  • In IE patients with CAD, adding CABG to valve surgery may increase the risk of postoperative stroke without conferring long-term survival benefits.
  • Consideration should be given to omitting concomitant CABG in IE patients with non-critical CAD, as it may not impact outcomes.
  • Further research, ideally a randomized trial, is needed due to limitations regarding data on CAD severity.
Abstract

Keywords:
cardiac surgeryconcomitant coronary artery bypass graftingendocarditisstrokevalve

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