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. 2022 Oct;50(5):1191-1202.
doi: 10.1007/s15010-022-01792-0. Epub 2022 Mar 15.

Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry

Michal Pazdernik  1   2 , Bernard Iung  3 , Bulent Mutlu  4 , François Alla  5 , Robert Riezebos  6 , William Kong  7 , Maria Carmo Pereira Nunes  8 , Luc Pierard  9 , Ilija Srdanovic  10 , Hirotsugu Yamada  11 , Andrea De Martino  12 , Marcelo Haertel Miglioranza  13 , Julien Magne  14 , Cornelia Piper  15 , Cécile Laroche  16 , Aldo P Maggioni  16   17 , Patrizio Lancellotti  18 , Gilbert Habib  19   20 , Christine Selton-Suty  21   22 ; EURO-ENDO Investigators group
Collaborators, Affiliations
Free article

Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry

Michal Pazdernik et al. Infection. 2022 Oct.
Free article

Erratum in

Abstract

Purpose: High mortality and a limited performance of valvular surgery are typical features of infective endocarditis (IE) in octogenarians, even though surgical treatment is a major determinant of a successful outcome in IE.

Methods: Data from the prospective multicentre ESC EORP EURO-ENDO registry were used to assess the prognostic role of valvular surgery depending on age.

Results: As compared to < 80 yo patients, ≥ 80 yo had lower rates of theoretical indication for valvular surgery (49.1% vs. 60.3%, p < 0.001), of surgery performed (37.0% vs. 75.5%, p < 0.001), and a higher in-hospital (25.9% vs. 15.8%, p < 0.001) and 1-year mortality (41.3% vs. 22.2%, p < 0.001). By multivariable analysis, age per se was not predictive of 1-year mortality, but lack of surgical procedures when indicated was strongly predictive (HR 2.98 [2.43-3.66]). By propensity analysis, 304 ≥ 80 yo were matched to 608 < 80 yo patients. Propensity analysis confirmed the lower rate of indication for valvular surgery (51.3% vs. 57.2%, p = 0.031) and of surgery performed (35.3% vs. 68.4%, p < 0.0001) in ≥ 80 yo. Overall mortality remained higher in ≥ 80 yo (in-hospital: HR 1.50[1.06-2.13], p = 0.0210; 1-yr: HR 1.58[1.21-2.05], p = 0.0006), but was not different from that of < 80 yo among those who had surgery (in-hospital: 19.7% vs. 20.0%, p = 0.4236; 1-year: 27.3% vs. 25.5%, p = 0.7176).

Conclusion: Although mortality rates are consistently higher in ≥ 80 yo patients than in < 80 yo patients in the general population, mortality of surgery in ≥ 80 yo is similar to < 80 yo after matching patients. These results confirm the importance of a better recognition of surgical indication and of an increased performance of surgery in ≥ 80 yo patients.

Keywords: Elderly; Infective endocarditis; Prognosis; Propensity analysis; Surgery.

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