Department of Cardiovascular Surgery, University Hospital Freiburg, Heart Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Department of Cardiology and Angiology, University Hospital Freiburg, Heart Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Thorac Cardiovasc Surg. 2024 Dec;72(8):579-586. doi: 10.1055/s-0042-1757600. Epub 2022 Oct 18.
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.
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.
ICA revealed a CAD in the majority of our patients ( = 36; 54%): One-vessel disease = 19 (28%), two-vessel disease = 6 (9%), and three-vessel disease = 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 ( = 8 [12%] vs. = 30 [18%]; < 0.001), while the incidence of postoperative bleeding was higher ( = 18 [27%] vs. = 22 [13%]; = 0.022). The new-onset stroke incidence was 5% in each group.
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.
经皮冠状动脉造影（ICA）是检测严重冠状动脉疾病（CAD）的必要手段，但一般不建议在感染性主动脉瓣心内膜炎患者中进行。本研究旨在评估术前 ICA 在主动脉瓣置换术前患者中的风险和获益。
2008 年 3 月至 2020 年 9 月，232 例感染性主动脉瓣心内膜炎患者接受手术治疗。其中 67 例（29%）患者接受了术前诊断性 ICA，并与未行术前 ICA 的患者进行了比较。我们收集了他们的基线特征，包括神经状态、既往心脏手术史，并回顾了术前超声心动图和 ICA 数据。评估了 ICA 后的术中数据和临床结局以及手术后的临床结局。
ICA 显示大多数患者（ = 36；54%）存在 CAD：单支血管病变 = 19 例（28%），两支血管病变 = 6 例（9%），三支血管病变 = 11 例（16%）。我们没有观察到术前诊断性 ICA 后的不良事件，特别是没有发现血栓栓塞并发症，包括中风、内脏或下肢缺血。在接受外科主动脉瓣置换术的患者中，有 20 例（30%）同时进行了冠状动脉旁路移植术。在接受术前 ICA 的患者中，术后住院死亡率显著降低（ = 8 [12%] vs. = 30 [18%]； < 0.001），而术后出血发生率更高（ = 18 [27%] vs. = 22 [13%]； = 0.022）。每组的新发中风发生率均为 5%。
采用多学科团队方法，对选择的主动脉瓣感染性心内膜炎患者进行 ICA 是安全的，不会导致不良临床结局，但具有重要的临床意义。
