Does Coronary Artery Bypass Grafting Concomitant to Valve Surgery Influence the Outcome in Patients with Active Infective Endocarditis?

Background: Cardiac surgery is required in approximately half of the patients with infective endocarditis (IE) and is associated with high mortality (11–35%) and neurological complications (20–50%). Besides the clinical status at presentation, it is the general notion that the higher the complexity of a surgical procedure, the higher the perioperative risk. We aimed to investigate the effect of concomitant CABG and valve surgery on mortality and postoperative stroke in patients with IE.

Methods: We retrospectively reviewed all charts, brain imaging, and follow-up data from patients underwent single or double valve surgery with or without CABG for IE between Jan-07 and August-15. We performed Chi-Square analysis and multivariate regression analysis.

Results: A total of 382 patients underwent single or double valve surgery for IE. Among these patients, 59 patients underwent concomitant CABG and valve surgery and 323 patients underwent isolated valve surgery. Patients who received concomitant CABG were significantly older (67.6± 10.3 vs. 61.7± 14.3, p = 0.002) and had higher EuroScore. The duration of CPB was significantly longer in patients with concomitant CABG (152.2 ± 68.6 vs. 118.9 ± 56.8 minutes, p < 0.001). In-hospital mortality was significantly higher in the concomitant CABG group (32.2%) compared with the isolated valve surgery group (19.5%). In multivariate analysis, concomitant CABG and valve surgery did not qualify as an independent predictor of in-hospital mortality (Odds ratio (OR): 1.20, confidence interval (CI):0.60–2.43, p = 0.607), while age, septic shock on admission, and duration of CPB did. Newly-occurring postoperative stroke was significantly higher in the concomitant CABG group (20.3%) compared with the isolated valve surgery group (9.3%) (OR: 2.50, CI: 1.19–5.21, p = 0.021). Multivariate analysis showed that concomitant CABG and valve surgery was an independent predictor of postoperative stroke (OR: 2.60, CI: 1.24–5.45, p = 0.011).

Conclusion: Our results show that concomitant CABG and valve surgery for patients with active infective endocarditis is not an independent predictor of in-hospital mortality, but for postoperative stroke. The unadjusted higher in-hospital mortality in the concomitant CABG group may be due to a longer duration of cardiopulmonary bypass. Other revascularization strategies such as performing CABG off pump or hybrid percutaneous coronary intervention might be considered in such high risk patients.

No conflict of interest has been declared by the author(s).