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Preoperative use and safety of coronary angiography for acute aortic valve infective endocarditis
  1. Guillaume Hekimian1,
  2. Myongchan Kim1,
  3. Stephanie Passefort1,
  4. Xavier Duval2,3,
  5. Michel Wolff4,
  6. Catherine Leport2,
  7. Carole Leplat5,
  8. Gabriel Steg1,6,
  9. Bernard Iung1,
  10. Alec Vahanian1,
  11. David Messika-Zeitoun1,6
  1. 1Cardiology Department, APHP and University Paris, Bichat Hospital, Paris, France
  2. 2APHP, Infectious Disease Department, APHP and University Paris, Bichat Hospital, Paris, France
  3. 3Center of Clinical Investigation CIC 007, APHP and University Paris, Bichat Hospital, Paris, France
  4. 4Intensive Care Unit, APHP and University Paris, Bichat Hospital, Paris, France
  5. 5Department of Epidemiology, Biostatistic and Clinical Research, APHP and University Paris, Bichat Hospital, Paris, France
  6. 6INSERM U 698, APHP and University Paris, Bichat Hospital, Paris, France
  1. Correspondence to Dr David Messika-Zeitoun, Cardiovascular Division, Bichat Hospital, 46 rue Henri Huchard, 75018 Paris, France; david.messika-zeitoun{at}bch.aphpfigr

Abstract

Background Preoperative coronary angiography (CA) is recommended in patients with acute aortic valve infective endocarditis (AV-IE) and high cardiovascular risk profile but the level of evidence is low and its potential interest may be counterbalanced by the risk of dislodgement of vegetations and contrast-induced nephropathy.

Objective To review the use, indications and complication of preoperative CA in patients with AV-IE.

Design Retrospective study.

Patients Consecutive series of 83 patients operated on for AV-IE between January 2002 and March 2007.

Results CA was performed in 36 (43%) patients, all but one as a preoperative test. Significant (≥70%) lesions were observed in 10 patients and six underwent an associated coronary artery bypass graft. 47 patients were operated on without preoperative CA because of young age in 16 or recent CA in 13. Despite being theoretically indicated in all but one of the 18 remaining patients, CA was not performed because surgery as judged too urgent (eight patients) or valvular lesions were estimated as too important (10 patients). While the 35 patients with preoperative CA tended to be healthier (longer time to surgery and lower rate of urgent surgery), anatomical lesions were not different (rate of severe regurgitation, periannular complications and vegetation size, all p>0.20). No embolic event occurred after CA and preoperative CA was not associated with increased in-hospital mortality (p=0.80) or worsening renal function (p=0.93).

Conclusion Preoperative CA can be performed at low risk in selected patients with AV-IE and should be considered before surgery in patients with cardiovascular risk factors. Our results support current guidelines.

  • Infective endocarditis
  • aortic valve
  • coronary angiography
  • complications

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Footnotes

  • Dr Messika-Zeitoun was supported by a contrat d'interface INSERM.

  • Competing interests None to declare.

  • Ethics approval The study is part of an ongoing registry set up in our institution with an IRB agreement.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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