Screening for coronary artery disease in early surgical treatment of acute aortic valve infective endocarditis
| Autor: | Ricardo P.J. Budde, Wilco Tanis, Nicolas M. Van Mieghem, Ad J.J.C. Bogers, Ali R. Wahadat, Wiebe G Knol, Jolien W. Roos-Hesselink |
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| Přispěvatelé: | Radiology & Nuclear Medicine, Cardiothoracic Surgery, Cardiology |
| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
Aortic valve medicine.medical_specialty Computed Tomography Angiography medicine.medical_treatment Coronary Artery Disease 030204 cardiovascular system & hematology Coronary Angiography Infections Revascularization Preoperative care Coronary artery disease 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans cardiovascular diseases Myocardial infarction Retrospective Studies Computed tomography angiography Adult Cardiac Endocarditis medicine.diagnostic_test business.industry Perioperative medicine.disease medicine.anatomical_structure 030228 respiratory system Embolism Aortic Valve cardiovascular system Cardiology Surgery Cardiology and Cardiovascular Medicine business |
| Zdroj: | Interact Cardiovasc Thorac Surg Interactive Cardiovascular and Thoracic Surgery, 32(4), 522-529. Oxford University Press |
| ISSN: | 1569-9285 1569-9293 |
| Popis: | OBJECTIVES In patients with unknown coronary status undergoing surgery for acute infective endocarditis (IE), the need to screen for coronary artery disease (CAD) and the risk of embolization during invasive coronary angiography (ICA) are debated. Coronary computed tomography angiography (CCTA) is a non-invasive alternative in these patients. We aimed to evaluate the safety and feasibility of ICA and CCTA to diagnose CAD, and the necessity to treat CAD to prevent CAD-related postoperative complications. METHODS In this single-centre retrospective cohort study, all patients with acute aortic IE between 2009 and 2019 undergoing surgery were selected. Outcomes were any clinically evident embolization after preoperative ICA, in-hospital mortality, perioperative myocardial infarction or unplanned revascularization and postoperative renal function. RESULTS Of the 159 included patients, CAD status was already known in 14. No preoperative diagnostics for CAD was done in 46/145, a CCTA was performed in 54/145 patients and an ICA in 52/145 patients. Significant CAD was found after CCTA in 22% and after ICA in 21% of patients. In 1 of the 52 (2%) patients undergoing preoperative ICA, a cerebral embolism occurred. The rate of perioperative myocardial infarction or unplanned revascularization in patients not screened for CAD was 2% (1 out of 46 patients). CONCLUSIONS Although the risk of embolism after preoperative ICA is low, it should be carefully weighed against the estimated risk of CAD-related perioperative complications. CCTA can serve as a gatekeeper for ICA in most patients with acute aortic IE. |
| Databáze: | OpenAIRE |
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