The Role of Coronary Catheterization with Angiography in Surgically Managed Infectious Endocarditis

Background: Coronary catheterization with angiography is often performed prior to surgical valve replacement in infectious endocarditis. There are no existing data as to whether this intervention is clinically necessary or leads to a change in surgical management. In order to determine the frequency with which coronary angiography impacts surgical management in infectious endocarditis, we conducted a retrospective review of surgically managed endocarditis cases at a tertiary care medical center. Methods: Utilizing the institutional Society of Thoracic Surgeon's database, we identified 598 patients with surgically managed endocarditis between April 29, 2011 and December 31, 2018. Patient variables were recorded, including risk factors for coronary artery disease, whether the patient received coronary angiography prior to surgery, and if the patient underwent coronary artery bypass grafting as part of their valve surgery. Results: There were 430 patients who received coronary catheterization with angiography prior to surgical valve replacement for infectious endocarditis, and 168 patients proceeded to surgery without coronary angiography. Nine percent of patients underwent coronary artery bypass grafting at the time of valve replacement as a result of coronary angiography findings. There was no significant difference in 30-day mortality for patients with endocarditis who underwent coronary angiography when compared with those who did not receive coronary angiography (2.6 vs 2.4%; P = 0.89). Conclusions: Left heart catheterization with coronary angiography prior to surgical valve replacement leads to coronary artery bypass grafting in the minority of infective endocarditis patients.