Invasive Coronary Angiography in Patients with Native or Prosthetic Aortic Valve Endocarditis

Abstract

Background Invasive coronary angiography (ICA) is essential to detect significant coronary artery disease (CAD) but is generally not recommended in patients with infective aortic valve endocarditis. This study aimed to evaluate the risks and benefits of preoperative ICA in patients before aortic valve replacement.

Methods Between March 2008 and September 2020, 232 patients were surgically treated for infectious endocarditis of the aortic valve. Sixty-seven (29%) of them underwent preoperative diagnostic ICA and were compared with the patients without preoperative ICA. We collected their baseline characteristics, including the neurological status, previous cardiac surgical procedures, and reviewed the preoperative echocardiograms and the ICA data. The intraoperative data and clinical outcomes after ICA and after surgery were evaluated.

Results ICA revealed a CAD in the majority of our patients (n = 36; 54%): One-vessel disease n = 19 (28%), two-vessel disease n = 6 (9%), and three-vessel disease n = 11 (16%). We observed no adverse events following preoperative diagnostic ICA, particularly no thromboembolic complications, including stroke, visceral, or lower body ischemia were detected. During surgical aortic valve replacement, concomitant coronary artery bypass grafting was performed in 20 patients (30%). In patients with preoperative ICA, postoperative in-hospital mortality was significantly lower (n = 8 [12%] vs. n = 30 [18%]; p < 0.001), while the incidence of postoperative bleeding was higher (n = 18 [27%] vs. n = 22 [13%]; p = 0.022). The new-onset stroke incidence was 5% in each group.

Conclusion Taking a multidisciplinary team approach, ICA is safe in selected patients with aortic valve infectious endocarditis with no adverse clinical outcomes, but significant clinical implications.

Keywords

aortic valve endocarditis - coronary angiography - coronary artery disease - coronary bypass grafting

Authors' Contributions

T.B.: conceptualization, formal analysis, methodology, and writing– original draft. D.D.: data curation, formal analysis, and writing – original draft. M.S. and C.P.: supervision and writing – review and editing. A.F.: visualization and writing – review and editing. W.Z.: writing – review and editing. F.B. and F.J.N.: conceptualization, and writing – review and editing. M.C.: project administration, supervision, and writing – review and editing. M.K.: conceptualization, methodology, supervision, validation, and writing – original draft. All authors contributed to the article and approved the submitted version.

Impact on Daily Practice

ICA was safe to perform and revealed CAD in the majority of our study population with significant clinical implication for revascularization. It therefore may be considered in preselected patients with native or prosthetic aortic valve endocarditis to reduce perioperative myocardial injury and improve clinical outcomes.

Ethical Approval Statement

IRB No. 20–1274 on 09/03/2021.

Publikationsverlauf

Eingereicht: 11. März 2022

Angenommen: 30. August 2022

Artikel online veröffentlicht:
18. Oktober 2022

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