Diab Mahmoud, Lehmann Thomas, Weber Carolyn, Petrov Georgi, Luehr Maximilian, Akhyari Payam, Tugtekin Sems-Malte, Schulze P Christian, Franz Marcus, Misfeld Martin, Borger Michael A, Matschke Klaus, Wahlers Thorsten, Lichtenberg Artur, Hagl Christian, Doenst Torsten
Department of Cardiothoracic Surgery, Jena University Hospital-Friedrich Schiller University of Jena, 07747 Jena, Germany.
Center of Clinical Studies, Jena University Hospital-Friedrich Schiller University of Jena, 07747 Jena, Germany.
J Clin Med. 2021 Jun 28;10(13):2867. doi: 10.3390/jcm10132867.
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.
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.
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%, = 0.003) and a trend towards higher postoperative hemodialysis (29% vs. 25%, = 0.052). Thirty-day mortality was similar in both groups (24% vs. 23%, = 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, = 0.998).
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.
目前的做法是，对于患有感染性心内膜炎（IE）且有相关冠状动脉疾病（CAD）的患者，同期进行冠状动脉旁路移植术（CABG）。然而，CABG可能会增加手术的复杂性。我们旨在研究同期CABG对IE手术患者围手术期结局的影响。
我们回顾性地使用了1994年至2018年期间德国六个心脏外科中心接受手术治疗的IE患者的数据。我们进行了逆概率加权（IPW）、多变量调整、卡方分析和Kaplan-Meier生存估计。
1242/4917（25%）例患者报告有CAD。其中，527例接受了同期CABG。使用IPW对CABG组和非CABG组患者的基础特征进行调整后，同期CABG与术后较高的卒中发生率相关（26%对21%，P = 0.003），且术后血液透析率有升高趋势（29%对25%，P = 0.052）。两组的30天死亡率相似（24%对23%，P = 0.370）。IPW后的多变量Cox回归分析显示，CABG与更好的长期生存无关（HR：1.00，95%CI：0.82 - 1.23，P = 0.998）。
在患有CAD的心内膜炎患者中，在瓣膜手术中增加CABG可能与术后卒中发生率较高相关，而不会增加长期生存益处。因此，在没有严重CAD的情况下，可以省略同期CABG而不影响结局。由于缺乏CAD严重程度的数据，结果受到限制，因此需要进行随机试验。
