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

Autor: Pazdernik M; Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.; Department of Cardiology, Second Medical School, Charles University, University Hospital Motol, Prague, Czech Republic., Iung B; Cardiology Department, Bichat Hospital, APHP, Université de Paris, Paris, France., Mutlu B; Department of Cardiology, Marmara University Hospital, Pendik, Istanbul, Turkey., Alla F; CHU de Bordeaux, Bordeaux, France., Riezebos R; Heart Center, OLVG, Amsterdam, Netherlands., Kong W; National University Heart Centre Singapore, Singapore, Singapore., Nunes MCP; Federal University of Minas Gerais, Belo Horizonte, Brazil., Pierard L; University Hospital Sart Tilman, University of Liege, Liege, Belgium., Srdanovic I; Medical Faculty University, Novi Sad, Serbia., Yamada H; Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan., De Martino A; University Hospital of Pisa, Pisa, Italy., Miglioranza MH; Brasil Institute of Cardiology/University Foundation, Porto Alegre, Brazil., Magne J; Cardiology Dept, CHU Limoges, INSERM 1094, University Hospital Dupuytren, 87042, Limoges, France., Piper C; Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen, Germany., Laroche C; EURObservational Research Programme, European Society of Cardiology, Biot, France., Maggioni AP; EURObservational Research Programme, European Society of Cardiology, Biot, France.; Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy., Lancellotti P; University Hospital of Liege (CHU), Liege, Belgium., Habib G; Cardiology Dept, APHM, La Timone Hospital, Marseille, France.; Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France., Selton-Suty C; Cardiology Dept, CIC-ECCHU Nancy-Brabois, 54000, Nancy, France. c.suty-selton@chru-nancy.fr.; Association pour l'Etude et la Prevention de l'Endocardite Infectieuse (AEPEI), Paris, France. c.suty-selton@chru-nancy.fr.
Jazyk: angličtina
Zdroj: Infection [Infection] 2022 Oct; Vol. 50 (5), pp. 1191-1202. Date of Electronic Publication: 2022 Mar 15.
DOI: 10.1007/s15010-022-01792-0
Abstrakt: 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.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
Databáze: MEDLINE
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