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.
Similar content being viewed by others
Change history
26 July 2022
A Correction to this paper has been published: https://doi.org/10.1007/s15010-022-01883-y
References
Habib G, Erba PA, Iung B, Donal E, Cosyns B, Laroche C, Popescu BA, Prendergast B, Tornos P, Sadeghpour A, Oliver L, Vaskelyte J-J, Sow R, Axler O, Maggioni AP, Lancellotti P, EURO-ENDO Investigators. Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study. Eur Heart J. 2019;40:3222–32.
Murdoch DR, Corey GR, Hoen B, Miro JM, Fowler VG, Bayer AS, Karchmer AW, Olaison L, Pappas PA, Moreillon P, Chambers ST, Chu VH, Falco V, Holland DJ, Jones P, Klein JL, Raymond NJ, Read KM, Tripodi MF, Utili R, Wang A, Woods CW, Cabell CH. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med. 2009;169:463–73.
Slipczuk L, Codolosa JN, Davila CD, Romero-Corral A, Yun J, Pressman GS, Figueredo VM. Infective endocarditis epidemiology over five decades: a systematic review. PLoS ONE. 2013;8: e82665.
Durante-Mangoni E, Bradley S, Selton-Suty C, Tripodi MF, Barsic B, Bouza E, Cabell CH, Ramos AI, Fowler V, Hoen B, Konecny P, Moreno A, Murdoch D, Pappas P, Sexton DJ, Spelman D, Tattevin P, Miro JM, van der Meer JT, Utili R. Current features of infective endocarditis in elderly patients: results of the International Collaboration on Endocarditis Prospective Cohort Study. Arch Intern Med. 2008;168:2095–103.
Oliver L, Lavoute C, Giorgi R, Salaun E, Hubert S, Casalta J-P, Gouriet F, Renard S, Saby L, Avierinos J-F, Maysou L-A, Riberi A, Grisoli D, Casalta A-C, Collart F, Raoult D, Habib G. Infective endocarditis in octogenarians. Heart. 2017;103:1602–9.
Forestier E, Roubaud-Baudron C, Fraisse T, Patry C, Gavazzi G, Hoen B, Carauz-Paz P, Moheb-Khosravi B, Delahaye F, Sost G, Paccalin M, Nazeyrollas P, Strady C, Alla F, Selton-Suty C. Comprehensive geriatric assessment in older patients suffering from infective endocarditis. A prospective multicentric cohort study. Clin Microbiol Infect. 2019;25:1246–52.
Lopez J, Revilla A, Vilacosta I, Sevilla T, Villacorta E, Sarria C, Pozo E, Rollan MJ, Gomez I, Mota P, San Roman JA. Age-dependent profile of left-sided infective endocarditis: a 3-center experience. Circulation. 2010;121:892–7.
Selton-Suty C, Hoen B, Grentzinger A, Houplon P, Maignan M, Juilliere Y, Danchin N, Canton P, Cherrier F. Clinical and bacteriological characteristics of infective endocarditis in the elderly. Heart. 1997;77:260–3.
Ghanta RK, Pettersson GB. Surgical treatment of infective endocarditis in elderly patients: the importance of shared decision making. J Am Heart Assoc. 2021;10(19): e022186. https://doi.org/10.1161/JAHA.121.022186 (Epub 2021 Sep 24. PMID: 34558288).
Ragnarsson S, Salto-Alejandre S, Ström A, Olaison L, Rasmussen M. Surgery is underused in elderly patients with left-sided infective endocarditis: a nationwide registry study. J Am Heart Assoc. 2021;10(19): e020221. https://doi.org/10.1161/JAHA.120.020221 (Epub 2021 Sep 24. PMID: 34558291).
Habib G, Lancellotti P, Erba P-A, Sadeghpour A, Meshaal M, Sambola A, Furnaz S, Citro R, Ternacle J, Donal E, Cosyns B, Popescu B, Iung B, Prendergast B, Laroche C, Tornos P, Pazdernik M, Maggioni A, Gale CP, EURO-ENDO Investigators. The ESC-EORP EURO-ENDO (European Infective Endocarditis) registry. Eur Heart J Qual Care Clin Outcomes. 2019;5:202–7.
Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL; ESC Scientific Document Group (2015) 2015 ESC Guidelines for the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36(44):3075–128. doi: https://doi.org/10.1093/eurheartj/ehv319. Epub 2015 Aug 29. PMID: 26320109.
Sy RW, Kritharides L. Health care exposure and age in infective endocarditis: results of a contemporary population-based profile of 1536 patients in Australia. Eur Heart J. 2010;31:1890–2187.
Polyzos KA, Konstantelias AA, Falagas ME. Risk factors for cardiac implantable electronic device infection: a systematic review and meta-analysis. Europace. 2015;17:767–77.
Chirouze C, Athan E, Alla F, Chu VH, Ralph Corey G, Selton-Suty C, Erpelding M-L, Miro JM, Olaison L, Hoen B, International Collaboration on Endocarditis Study Group. Enterococcal endocarditis in the beginning of the 21st century: analysis from the International Collaboration on Endocarditis-Prospective Cohort Study. Clin Microbiol Infect. 2013;19:1140–7.
Summers MR, Leon MB, Smith CR, Kodali SK, Thourani VH, Herrmann HC, Makkar RR, Pibarot P, Webb JG, Leipsic J, Alu MC, Crowley A, Hahn RT, Kapadia SR, Tuzcu EM, Svensson L, Cremer PC, Jaber WA. Prosthetic valve endocarditis after TAVR and SAVR: insights from the PARTNER trials. Circulation. 2019;140:1984–94.
Cahill TJ, Baddour LM, Habib G, Hoen B, Salaun E, Pettersson GB, Schäfers HJ, Prendergast BD. Challenges in infective endocarditis. J Am Coll Cardiol. 2017;69:325–44.
Chu VH, Park LP, Athan E, Delahaye F, Freiberger T, Lamas C, Miro JM, Mudrick DW, Strahilevitz J, Tribouilloy C, Durante-Mangoni E, Pericas JM, Fernández-Hidalgo N, Nacinovich F, Rizk H, Krajinovic V, Giannitsioti E, Hurley JP, Hannan MM, Wang A, International Collaboration on Endocarditis (ICE) Investigators. Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: a prospective study from the International Collaboration on Endocarditis. Circulation. 2015;131:131–40.
Iung B, Doco-Lecompte T, Chocron S, Strady C, Delahaye F, Le Moing V, Poyart C, Alla F, Cambau E, Tattevin P, Chirouze C, Obadia J-F, Duval X, Hoen B, AEPEI Study Group. Cardiac surgery during the acute phase of infective endocarditis: discrepancies between European Society of Cardiology guidelines and practices. Eur Heart J. 2016;37:840–8.
López-Wolf D, Vilacosta I, San Román JA, Fernández C, Sarriá C, López J, Revilla A, Manchado R. Infective endocarditis in octogenarian patients. Rev Esp Cardiol. 2011;64:329–33.
Acknowledgements
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.
Funding
This work was supported by Abbott Vascular Int. (2011–2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2019), Daiichi Sankyo Europe GmbH (2011–2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2016), Menarini Int. Op. (2009–2012), MSD-Merck & Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), SERVIER (2009–2021), Vifor (2019–2022).
Author information
Authors and Affiliations
Consortia
Corresponding author
Ethics declarations
Informed consent
Informed consent was obtained from all individual participants included in the study. Our study complies with the Declaration of Helsinki, the research protocol has been approved by the locally appointed ethics committee; informed consent has been obtained from all the subjects (or their legally authorized representative).
Ethical approval
Our study complies with all ethical standards.
Conflict of interest
François Alla, Ilija Srdanović, Robert Riezebos, William KF Kong, Maria Carmo Pereira Nunes, Michal Pazderník, Luc Pierard, Bülent Mutlu, Hirotsugu Yamada, Andrea De Martino, Marcelo Haertel Miglioranza, Julien Magne, Cornelia Piper, Cécile Laroche, Patrizio Lancellotti, Gilbert Habib, Christine Selton-Suty have nothing to disclose. Bernard Iung reports personal fees from Edwards Lifesciences, other from Boehringer Ingelheim, outside the submitted work. Aldo P. Maggioni reports personal fees from Bayer, personal fees from Fresenius, personal fees from Novartis, outside the submitted work.
Additional information
The original online version of this article was revised: In this article the "EURO-ENDO Investigators group" member U. Y. Sinan was incorrectly written as U. S. Yasar.
A complete list of the EURO-ENDO Investigators Group is provided in Supplementary Material Appendix 1.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Pazdernik, M., Iung, B., Mutlu, B. et al. Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry. Infection 50, 1191–1202 (2022). https://doi.org/10.1007/s15010-022-01792-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s15010-022-01792-0