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

Zobrazit více v PubMed

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. DOI

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. DOI

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. DOI

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. DOI

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. DOI

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. DOI

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. DOI

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. DOI

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). PubMed DOI PMC

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). PubMed DOI PMC

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. DOI

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. DOI

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. DOI

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. DOI

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. DOI

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. DOI

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. DOI

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. DOI

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. DOI

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