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Spanneut TA, Paquet P, Bauters C, Modine T, Richardson M, Bonello L, Juthier F, Lemesle G. Utility and safety of coronary angiography in patients with acute infective endocarditis who required surgery. J Thorac Cardiovasc Surg 2020; 164:905-913.e19. [PMID: 33131891 DOI: 10.1016/j.jtcvs.2020.08.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/09/2020] [Accepted: 08/15/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To assess the benefit/risk ratio to perform a coronary angiography (CA) before surgery for infective endocarditis (IE). METHODS We conducted a single-center prospective registry including 272 patients with acute IE intended for surgery and compared patients who underwent a preoperative CA (n = 160) with those who did not (n = 112). A meta-analysis of 3 observational studies was also conducted and included 551 patients: 342 who underwent a CA and 209 who did not. RESULTS In our registry, combined bypass surgery (CABG) was performed in 17% of the patients with preoperative CA. At 2 years, the rate of the primary composite end point (all-cause death, new systemic embolism, stroke, new hemodialysis) was similar in the CA (38%) and no-CA (37%) groups. In-hospital and 2-year individual end points were all similar between groups. There were only 2 episodes of systemic embolism after CA and only one possibly related to a vegetation dislodgement. In the meta-analysis, combined CABG was performed in 18% of the patients with preoperative CA. All-cause death was similar in both groups: odds ratio, 0.98 [0.62-1.53], P = .92. Only 5 cases of systemic embolism possibly related to a vegetation dislodgement were reported. New hemodialysis was numerically more frequent in the CA group: odds ratio, 1.68 [0.79-3.58] (18% vs 14%, P = .18). CONCLUSIONS In daily practice, two-thirds of the patients with acute IE who required surgery have a preoperative CA leading to a combined CABG in 18% of the patients. Our results suggest that to perform a preoperative CA in this context is not associated with improved prognosis.
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Affiliation(s)
- Théo-Alexandre Spanneut
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Pierre Paquet
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Christophe Bauters
- Service de Cardiologie, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France; INSERM UMR 1067, Institut Pasteur de Lille, Lille, France; Faculté de Médecine de l'Université de Lille, Lille, France
| | - Thomas Modine
- Service de chirurgie cardiaque et vasculaire, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Marjorie Richardson
- Service d'exploration fonctionnelle cardiovasculaire, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Laurent Bonello
- Service de Cardiologie, Hopital Nord de Marseille, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Francis Juthier
- Faculté de Médecine de l'Université de Lille, Lille, France; Service de chirurgie cardiaque et vasculaire, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France; INSERM UMR 1011, Institut Pasteur de Lille, Lille, France
| | - Gilles Lemesle
- USIC et Centre Hémodynamique, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France; Faculté de Médecine de l'Université de Lille, Lille, France; INSERM UMR 1011, Institut Pasteur de Lille, Lille, France; FACT (French Alliance for Cardiovascular Trials), Paris, France.
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Abstract
Since early investigators first suggested that the treatment of endocarditis should include valve replacement for infections not readily controlled with medical therapy alone, the role of surgery has become expanded, yet refined, to improve the outcome of patients with this potentially fatal disease. Innovative surgical techniques have also been developed in an effort to improve the results of surgical treatment for complex sequelae of invasive infections. This article examines the current indications for surgical intervention, compares the various surgical options, and assesses the expected short-and long-term outcome after valve replacement for patients with native valve or prosthetic valve endocarditis.
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Affiliation(s)
- M R Moon
- Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, California 94305-5247, USA
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Hunter GJ, Thomas H, Treasure T, Sturridge MF, Swanton RH. Demonstration of the ascending aorta in infective endocarditis by intravenous digital subtraction angiography. Heart 1988; 60:252-8. [PMID: 3052553 PMCID: PMC1216563 DOI: 10.1136/hrt.60.3.252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Four patients with infective endocarditis were examined by digital subtraction angiography immediately before operation. In three a root abscess was suspected and the remaining patient was believed to have a false aneurysm at an infected aortic cannulation site. In all the cases digital subtraction angiography showed the structure in several projections and confirmed the presence of a cavity. Subsequent operation confirmed the site and nature of the lesions.
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Affiliation(s)
- G J Hunter
- Department of Radiology, Middlesex Hospital, London
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Abstract
Infective endocarditis remains a serious illness with a high mortality. In more than 75% of 417 patients, the infection was due to gram-positive microorganisms. The non-drug-addicted patients (33%) were elderly and debilitated with advanced illness that preceded the endocarditis. The drug-addicted patients (67%) were young and were infected with multiple kinds of microorganisms. The blood cultures grew strains of Staphylococcus aureus resistant to methicillin sodium and nafcillin sodium in a majority of patients. Gram-negative microorganisms and fungi were cultured almost exclusively from samples from the drug-addicted patients. The high mortality among the non-drug-addicted patients (28%) was related to their advanced age and debilitating illness. The high mortality among the drug-addicted patients (21%) was related to the complex bacteriology of their infections and the severe anatomical disruption of the valvular complexes of the heart. When cured of their disease after treatment with intravenously administered antibiotics or a valve procedure or both, their long-term survival was related to whether or not they abstained from their habit. If the patient abstained from the use of drugs, the chances of survival were good; if not, death invariably ensued. This experience strongly supports our contention that if a patient returns to the use of drugs and reinfects the valve after initial cure, a second valve operation is contraindicated.
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