Infective endocarditis requiring surgical intervention: Safety and therapeutic impact of preoperative coronary angiography

Abstract

Preoperative coronary angiography (CA) cannot be performed systematically in patients with infective endocarditis requiring surgical treatment due to a high risk of embolization, in cases of aortic endocarditis, or when abscesses or vegetations are present. The aim of this study is to assess the safety and the therapeutic impact of preoperative coronary angiography in infective endocarditis requiring surgery. This monocentric, observational study included patients with infective endocarditis requiring surgical treatment who were hospitalized between March 2013 and December 2016 in Rangueil Hospital. The outcome were i) the occurrence of post-CA complications, such as neurological embolization, acute kidney failure requiring postoperative dialysis, or ii) necessity for surgical myocardial revascularization, and the mortality at 28 days and one year. Hundred and ninety-three patients were included in this study, among which 119 had aortic endocarditis. Hundred and fifty-five patients had theoretical indication of CA and 142 interventions were performed. The procedure was carried out regardless of the location of the endocarditis, whether it was aortic or not ( P = 0.39), and regardless of the existence of abscesses and/or adenoids ( P = 0.09), even in case of emergency surgery ( P = 0.79). Neurological embolization occurred after angiography in only 2 patients with mitral endocarditis, and none was observed in patients with aortic endocarditis. Surgery was performed in 173 patients, and 25 of them had a myocardial revascularization. No increase in postoperative dialysis rate was observed ( P = 0.43) and there were no differences in the mortality rates, neither at 28 days ( P = 0.77) nor at 12 months following surgery ( P = 0.59). Preoperative CA was not associated with a higher occurrence of complications, such as embolizaton or postoperative acute kidney failure, and did not decrease postoperative mortality in infective endocarditis (aortic or not) requiring surgery.