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Article

Role of Concomitant Coronary Artery Bypass Grafting in Valve Surgery for Infective Endocarditis

by
Mahmoud Diab
1,
Thomas Lehmann
2,
Carolyn Weber
3,
Georgi Petrov
4,
Maximilian Luehr
3,
Payam Akhyari
4,
Sems-Malte Tugtekin
5,
P. Christian Schulze
6,
Marcus Franz
6,
Martin Misfeld
7,8,
Michael A. Borger
8,
Klaus Matschke
5,
Thorsten Wahlers
3,
Artur Lichtenberg
4,
Christian Hagl
9 and
Torsten Doenst
1,*
1
Department of Cardiothoracic Surgery, Jena University Hospital-Friedrich Schiller University of Jena, 07747 Jena, Germany
2
Center of Clinical Studies, Jena University Hospital-Friedrich Schiller University of Jena, 07747 Jena, Germany
3
Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, 50937 Colonge, Germany
4
Department of Cardiothoracic Surgery, Heinrich-Heine-University Duesseldorf, 40225 Duesseldof, Germany
5
Department of Cardiac Surgery, Heart Center Dresden, 01307 Dresden, Germany
6
Department of Internal Medicine I, Jena University Hospital-Friedrich Schiller University of Jena, 07747 Jena, Germany
7
Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney 2050, Australia
8
Department of Cardiac Surgery, Heart Center Leipzig, 04289 Leipzig, Germany
9
Department of Cardiac Surgery, Ludwig Maximilian University Munich, 80539 Munich, Germany
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2021, 10(13), 2867; https://doi.org/10.3390/jcm10132867
Submission received: 6 May 2021 / Revised: 31 May 2021 / Accepted: 24 June 2021 / Published: 28 June 2021
(This article belongs to the Section Cardiology)
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Abstract

Background: It is current practice to perform concomitant coronary artery bypass grafting (CABG) in patients with infective endocarditis (IE) who have relevant coronary artery disease (CAD). However, CABG may add complexity to the operation. We aimed to investigate the impact of concomitant CABG on perioperative outcomes in patients undergoing surgery for IE. Methods: We retrospectively used data of surgically treated IE patients between 1994 and 2018 in six German cardiac surgery centers. We performed inverse probability weighting (IPW), multivariable adjustment, chi-square analysis, and Kaplan–Meier survival estimates. Results: CAD was reported in 1242/4917 (25%) patients. Among them, 527 received concomitant CABG. After adjustment for basal characteristics between CABG and no-CABG patients using IPW, concomitant CABG was associated with higher postoperative stroke (26% vs. 21%, p = 0.003) and a trend towards higher postoperative hemodialysis (29% vs. 25%, p = 0.052). Thirty-day mortality was similar in both groups (24% vs. 23%, p = 0.370). Multivariate Cox regression analysis after IPW showed that CABG was not associated with better long-term survival (HR: 1.00, 95% CI: 0.82–1.23, p = 0.998). Conclusion: In endocarditis patients with CAD, adding CABG to valve surgery may be associated with a higher likelihood of postoperative stroke without adding long-term survival benefits. Therefore, in the absence of critical CAD, concomitant CABG may be omitted without impacting outcome. The results are limited due to a lack of data on the severity of CAD, and therefore there is a need for a randomized trial.
Keywords: valve; endocarditis; concomitant coronary artery bypass grafting; stroke; cardiac surgery valve; endocarditis; concomitant coronary artery bypass grafting; stroke; cardiac surgery

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MDPI and ACS Style

Diab, M.; Lehmann, T.; Weber, C.; Petrov, G.; Luehr, M.; Akhyari, P.; Tugtekin, S.-M.; Schulze, P.C.; Franz, M.; Misfeld, M.; et al. Role of Concomitant Coronary Artery Bypass Grafting in Valve Surgery for Infective Endocarditis. J. Clin. Med. 2021, 10, 2867. https://doi.org/10.3390/jcm10132867

AMA Style

Diab M, Lehmann T, Weber C, Petrov G, Luehr M, Akhyari P, Tugtekin S-M, Schulze PC, Franz M, Misfeld M, et al. Role of Concomitant Coronary Artery Bypass Grafting in Valve Surgery for Infective Endocarditis. Journal of Clinical Medicine. 2021; 10(13):2867. https://doi.org/10.3390/jcm10132867

Chicago/Turabian Style

Diab, Mahmoud, Thomas Lehmann, Carolyn Weber, Georgi Petrov, Maximilian Luehr, Payam Akhyari, Sems-Malte Tugtekin, P. Christian Schulze, Marcus Franz, Martin Misfeld, and et al. 2021. "Role of Concomitant Coronary Artery Bypass Grafting in Valve Surgery for Infective Endocarditis" Journal of Clinical Medicine 10, no. 13: 2867. https://doi.org/10.3390/jcm10132867

APA Style

Diab, M., Lehmann, T., Weber, C., Petrov, G., Luehr, M., Akhyari, P., Tugtekin, S.-M., Schulze, P. C., Franz, M., Misfeld, M., Borger, M. A., Matschke, K., Wahlers, T., Lichtenberg, A., Hagl, C., & Doenst, T. (2021). Role of Concomitant Coronary Artery Bypass Grafting in Valve Surgery for Infective Endocarditis. Journal of Clinical Medicine, 10(13), 2867. https://doi.org/10.3390/jcm10132867

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