Details

Autor(en) / Beteiligte

• Pazdernik, Michal
• Iung, Bernard
• Mutlu, Bulent
• Alla, François
• Riezebos, Robert
• Kong, William
• Nunes, Maria Carmo Pereira
• Pierard, Luc
• Srdanovic, Ilija
• Yamada, Hirotsugu
• De Martino, Andrea
• Miglioranza, Marcelo Haertel
• Magne, Julien
• Piper, Cornelia
• Laroche, Cécile
• Maggioni, Aldo P.
• Lancellotti, Patrizio
• Habib, Gilbert
• Selton-Suty, Christine

Titel

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

Ist Teil von

• Infection, 2022-10, Vol.50 (5), p.1191-1202

Ort / Verlag

Berlin/Heidelberg: Springer Berlin Heidelberg

Erscheinungsjahr

2022

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• 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.