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

Mahmoud Diab,Carolyn Weber,Thorsten Wahlers,Payam Akhyari,Sems-Malte Tugtekin,Martin Misfeld,Thomas Lehmann,Michael A Borger,Georgi Petrov,Klaus Matschke,Torsten Doenst,Artur Lichtenberg,Marcus Franz,P Christian Schulze,Christian Hagl,Maximilian Luehr

doi:10.3390/jcm10132867

Abstract

Background: It is current practice to perform concomitant coronary artery bypass grafting (CABG) in patients with infective endocarditis (IE) who have relevant coronary artery disease (CAD). However, CABG may add complexity to the operation. We aimed to investigate the impact of concomitant CABG on perioperative outcomes in patients undergoing surgery for IE. Methods: We retrospectively used data of surgically treated IE patients between 1994 and 2018 in six German cardiac surgery centers. We performed inverse probability weighting (IPW), multivariable adjustment, chi-square analysis, and Kaplan–Meier survival estimates. Results: CAD was reported in 1242/4917 (25%) patients. Among them, 527 received concomitant CABG. After adjustment for basal characteristics between CABG and no-CABG patients using IPW, concomitant CABG was associated with higher postoperative stroke (26% vs. 21%, p = 0.003) and a trend towards higher postoperative hemodialysis (29% vs. 25%, p = 0.052). Thirty-day mortality was similar in both groups (24% vs. 23%, p = 0.370). Multivariate Cox regression analysis after IPW showed that CABG was not associated with better long-term survival (HR: 1.00, 95% CI: 0.82–1.23, p = 0.998). Conclusion: In endocarditis patients with CAD, adding CABG to valve surgery may be associated with a higher likelihood of postoperative stroke without adding long-term survival benefits. Therefore, in the absence of critical CAD, concomitant CABG may be omitted without impacting outcome. The results are limited due to a lack of data on the severity of CAD, and therefore there is a need for a randomized trial.

Highlights

Infective endocarditis (IE) is a serious disease carrying a considerable risk of 1-year mortality [1,2]
coronary artery disease (CAD) with and higher after incidence adjustingoffor the in basal characteristics, concomitant waswith associated postopdifferences in basal characteristics, concomitant was associated with higher erative stroke and a trend to more postoperative hemodialysis without adding a survival incidence of postoperative stroke and a trend toismore postoperative hemodialysis without benefit
We previously showed that septic shock resulting in multiple organ dysfunction syndrome (MODS) was the cause of death in 88% of patients who died after cardiac surgery for infective endocarditis (IE) [19]

Summary

Introduction

Infective endocarditis (IE) is a serious disease carrying a considerable risk of 1-year mortality [1,2]. The presence of infected tissues makes valve surgery for active IE technically more difficult than for non-IE pathologies Despite these technical challenges, valve surgery is an independent predictor for better short- and long-term survival in patients with IE [4]. The current guidelines for patients undergoing aortic valve replacement (AVR) for non-IE pathologies recommend performing CABG to all significant coronary stenoses [6]. It is current practice to perform concomitant coronary artery bypass grafting (CABG) in patients with infective endocarditis (IE) who have relevant coronary artery disease (CAD).

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Conclusion