TY - JOUR
T1 - Surgery and outcome of infective endocarditis in octogenarians
T2 - prospective data from the ESC EORP EURO-ENDO registry
AU - the EURO-ENDO Investigators group
AU - Pazdernik, Michal
AU - Iung, Bernard
AU - Mutlu, Bulent
AU - Alla, François
AU - Riezebos, Robert
AU - Kong, William
AU - Nunes, Maria Carmo Pereira
AU - Pierard, Luc
AU - Srdanovic, Ilija
AU - Yamada, Hirotsugu
AU - De Martino, Andrea
AU - Miglioranza, Marcelo Haertel
AU - Magne, Julien
AU - Piper, Cornelia
AU - Laroche, Cécile
AU - Maggioni, Aldo P.
AU - Lancellotti, Patrizio
AU - Habib, Gilbert
AU - Selton-Suty, Christine
AU - Ronderos, R.
AU - Avegliano, G.
AU - Oses, P. Fernandez
AU - Filipini, E.
AU - Granada, I.
AU - Iribarren, A.
AU - Mahia, M.
AU - Nacinovich, F.
AU - Ressi, S.
AU - Obregon, R.
AU - Bangher, M.
AU - Dho, J.
AU - Cartasegna, L.
AU - Plastino, M. L.
AU - Novas, V.
AU - Shigel, C.
AU - Reyes, G.
AU - De Santos, M.
AU - Gastaldello, N.
AU - Fernandez, M. Granillo
AU - Potito, M.
AU - Streitenberger, G.
AU - Velazco, P.
AU - Casabé, J. H.
AU - Cortes, C.
AU - Guevara, E.
AU - Salmo, F.
AU - Seijo, M.
AU - Weidinger, F.
AU - Heger, M.
AU - Strahilevitz, J.
N1 - Funding Information:
EORP Oversight Committee, Registry Executive and Steering Committees. The Data collection was conducted by the EORP department of the ESC: Emanuela Fiorucci, as Project Officer; Viviane Missiamenou, Florian Larras, and Rachid Mir Hassaine, as Data Managers. Statistical analyses were performed by Cécile Laroche of the EURObservational Research Programme, European Society of Cardiology, France. Overall activities were coordinated and supervised by Doctor Aldo P. Maggioni (EORP Scientific Coordinator). Special thanks to the EACVI (European Association of CardioVascular Imaging), to the ESC Working Group on Valvular Heart Disease and to the AEPEI (Association pour l’Etude et la Prévention de l’Endocardite Infectieuse) for their support.
Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
PY - 2022/10
Y1 - 2022/10
N2 - 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.
AB - 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.
KW - Elderly
KW - Infective endocarditis
KW - Prognosis
KW - Propensity analysis
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=85127808545&partnerID=8YFLogxK
U2 - 10.1007/s15010-022-01792-0
DO - 10.1007/s15010-022-01792-0
M3 - Article
C2 - 35290614
AN - SCOPUS:85127808545
SN - 0300-8126
VL - 50
SP - 1191
EP - 1202
JO - Infection
JF - Infection
IS - 5
ER -
