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.

Aix Marseille Univ IRD APHM MEPHI IHU Méditerranée Infection Marseille France

Association pour l'Etude et la Prevention de l'Endocardite Infectieuse Paris France

Brasil Institute of Cardiology University Foundation Porto Alegre Brazil

Cardiology Department Bichat Hospital APHP Université de Paris Paris France

Cardiology Dept APHM La Timone Hospital Marseille France

Cardiology Dept CHU Limoges INSERM 1094 University Hospital Dupuytren 87042 Limoges France

Cardiology Dept CIC ECCHU Nancy Brabois 54000 Nancy France

CHU de Bordeaux Bordeaux France

Department of Cardiology 2nd Medical School Charles University University Hospital Motol Prague Czech Republic

Department of Cardiology Marmara University Hospital Pendik Istanbul Turkey

EURObservational Research Programme European Society of Cardiology Biot France

Federal University of Minas Gerais Belo Horizonte Brazil

Heart Center OLVG Amsterdam Netherlands

Herz und Diabeteszentrum NRW Universitätsklinikum der Ruhr Universität Bochum Bad Oeynhausen Germany

Institute for Clinical and Experimental Medicine Prague Czech Republic

Maria Cecilia Hospital GVM Care and Research Cotignola Italy

Medical Faculty University Novi Sad Serbia

National University Heart Centre Singapore Singapore Singapore

Tokushima University Graduate School of Biomedical Sciences Tokushima Japan

University Hospital of Liege Liege Belgium

University Hospital of Pisa Pisa Italy

University Hospital Sart Tilman University of Liege Liege Belgium

Infection. 2022 Oct;50(5):1203-1204. doi: 10.1007/s15010-022-01883-y. PubMed

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Cardiac device-related infective endocarditis need for lead extraction whatever the device according to the ESC EORP EURO-ENDO registry