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.

Pazdernik, M., Iung, B., Mutlu, B., Alla, F., Riezebos, R., Kong, W., et al. (2022). Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry. INFECTION [10.1007/s15010-022-01792-0].

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

Badano L.
Membro del Collaboration Group
;
Muraru D.
Membro del Collaboration Group
;
Giannattasio C.
Membro del Collaboration Group
;
Moreo A.
Membro del Collaboration Group
;
De Chiara B.
Membro del Collaboration Group
;
Russo C. F.
Membro del Collaboration Group
;
2022

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.
Articolo in rivista - Articolo scientifico
Elderly; Infective endocarditis; Prognosis; Propensity analysis; Surgery;
English
Badano, L; Muraru, D; Giannattasio, C; Moreo, A; De Chiara, BC; Russo, CF on behalf of the EURO-ENDO Investigators group
Pazdernik, M., Iung, B., Mutlu, B., Alla, F., Riezebos, R., Kong, W., et al. (2022). Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry. INFECTION [10.1007/s15010-022-01792-0].
Pazdernik, M; Iung, B; Mutlu, B; Alla, F; Riezebos, R; Kong, W; Nunes, M; Pierard, L; Srdanovic, I; Yamada, H; De Martino, A; Miglioranza, M; Magne, J; Piper, C; Laroche, C; Maggioni, A; Lancellotti, P; Habib, G; Selton-Suty, C; Ronderos, R; Avegliano, G; Oses, P; Filipini, E; Granada, I; Iribarren, A; Mahia, M; Nacinovich, F; Ressi, S; Obregon, R; Bangher, M; Dho, J; Cartasegna, L; Plastino, M; Novas, V; Shigel, C; Reyes, G; De Santos, M; Gastaldello, N; Fernandez, M; Potito, M; Streitenberger, G; Velazco, P; Casabe, J; Cortes, C; Guevara, E; Salmo, F; Seijo, M; Weidinger, F; Heger, M; Brooks, R; Stollberger, C; Ho, C; Perschy, L; Puskas, L; Goliasch, G; Binder, C; Rosenhek, R; Schneider, M; Winter, M; Hoffer, E; Melissopoulou, M; Lecoq, E; Legrand, D; Jacquet, S; Massoz, M; Lancellotti, P; Pierard, L; Dulgheru, R; Marchetta, S; Demal, C; Oury, C; Cosyns, B; Droogmans, S; Kerkhove, D; Motoc, A; Plein, D; Roosens, B; Soens, L; Weytjens, C; Lemoine, I; Rodrigus, I; Paelinck, B; Amsel, B; 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