Preoperative use and safety of coronary angiography for acute aortic valve infective endocarditis

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.