To make it possible to do angiography and surgery on the same day and largely diminish the possibility of renal failure, Mayo physicians use other contrast agents. They minimize the total amount of contrast and carefully screen patients at risk for kidney disease. Different agents are used based on the patients kidney function, Dr. Holmes says.

In addition, deciding which patients may benefit from this streamlined approach is dependent on careful patient assessment and collaboration between the cardiologist and cardiovascular surgeon, he says.

Mayo researchers evaluated the medical records of 226 consecutive patients who had undergone cardiac catheterization on the day of elective valve repair or replacement between August 2000 and August 2004. The average age of the patient was 65 years old and 33 percent were female. Of the 226, angiography showed that 28.3 percent had severe enough coronary artery disease to also require bypass surgery, in addition to valve surgery. One patient died within 30 days following surgery, and four of the patients had transient renal failure.