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

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A Correction to this article was published on 26 July 2022

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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.

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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

  1. Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic

    Michal Pazdernik

  2. Department of Cardiology, Second Medical School, Charles University, University Hospital Motol, Prague, Czech Republic

    Michal Pazdernik

  3. Cardiology Department, Bichat Hospital, APHP, Université de Paris, Paris, France

    Bernard Iung

  4. Department of Cardiology, Marmara University Hospital, Pendik, Istanbul, Turkey

    Bulent Mutlu

  5. CHU de Bordeaux, Bordeaux, France

    François Alla

  6. Heart Center, OLVG, Amsterdam, Netherlands

    Robert Riezebos

  7. National University Heart Centre Singapore, Singapore, Singapore

    William Kong

  8. Federal University of Minas Gerais, Belo Horizonte, Brazil

    Maria Carmo Pereira Nunes

  9. University Hospital Sart Tilman, University of Liege, Liege, Belgium

    Luc Pierard

  10. Medical Faculty University, Novi Sad, Serbia

    Ilija Srdanovic

  11. Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan

    Hirotsugu Yamada

  12. University Hospital of Pisa, Pisa, Italy

    Andrea De Martino

  13. Brasil Institute of Cardiology/University Foundation, Porto Alegre, Brazil

    Marcelo Haertel Miglioranza

  14. Cardiology Dept, CHU Limoges, INSERM 1094, University Hospital Dupuytren, 87042, Limoges, France

    Julien Magne

  15. Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen, Germany

    Cornelia Piper

  16. EURObservational Research Programme, European Society of Cardiology, Biot, France

    Cécile Laroche & Aldo P. Maggioni

  17. Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy

    Aldo P. Maggioni

  18. University Hospital of Liege (CHU), Liege, Belgium

    Patrizio Lancellotti

  19. Cardiology Dept, APHM, La Timone Hospital, Marseille, France

    Gilbert Habib

  20. Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France

    Gilbert Habib

  21. Cardiology Dept, CIC-ECCHU Nancy-Brabois, 54000, Nancy, France

    Christine Selton-Suty

  22. Association pour l’Etude et la Prevention de l’Endocardite Infectieuse (AEPEI), Paris, France

    Christine Selton-Suty

Authors
  1. Michal Pazdernik
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  2. Bernard Iung
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  4. François Alla
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  5. Robert Riezebos
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  6. William Kong
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  7. Maria Carmo Pereira Nunes
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  8. Luc Pierard
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  10. Hirotsugu Yamada
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  11. Andrea De Martino
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  12. Marcelo Haertel Miglioranza
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  13. Julien Magne
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  14. Cornelia Piper
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  15. Cécile Laroche
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  16. Aldo P. Maggioni
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  17. Patrizio Lancellotti
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  18. Gilbert Habib
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  19. Christine Selton-Suty
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the EURO-ENDO Investigators group

  • R. Ronderos
  • , G. Avegliano
  • , P. Fernandez Oses
  • , E. Filipini
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  • , A. Iribarren
  • , M. Mahia
  • , F. Nacinovich
  • , S. Ressi
  • , R. Obregon
  • , M. Bangher
  • , J. Dho
  • , L. Cartasegna
  • , M. L. Plastino
  • , V. Novas
  • , C. Shigel
  • , G. Reyes
  • , M. De Santos
  • , N. Gastaldello
  • , M. Granillo Fernandez
  • , M. Potito
  • , G. Streitenberger
  • , P. Velazco
  • , J. H. Casabé
  • , C. Cortes
  • , E. Guevara
  • , F. Salmo
  • , M. Seijo
  • , F. Weidinger
  • , M. Heger
  • , R. Brooks
  • , C. Stöllberger
  • , C.-Y. Ho
  • , L. Perschy
  • , L. Puskas
  • , G. Goliasch
  • , C. Binder
  • , R. Rosenhek
  • , M. Schneider
  • , M.-P. Winter
  • , E. Hoffer
  • , M. Melissopoulou
  • , E. Lecoq
  • , D. Legrand
  • , S. Jacquet
  • , M. Massoz
  • , P. Lancellotti
  • , L. Pierard
  • , R. Dulgheru
  • , S. Marchetta
  • , C. D´Emal
  • , C. Oury
  • , B. Cosyns
  • , S. Droogmans
  • , D. Kerkhove
  • , A. Motoc
  • , D. Plein
  • , B. Roosens
  • , L. Soens
  • , C. Weytjens
  • , I. Lemoine
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  • , B. Amsel
  • , P. Unger
  • , D. Konopnicki
  • , C. Beauloye
  • , A. Pasquet
  • , S. Pierard
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  • , F. Sinnaeve
  • , J. L. Andrade
  • , A. C. Tude Rodrigues
  • , K. Staszko
  • , R. Dos Santos Monteiro
  • , M. H. Miglioranza
  • , D. L. Shuha
  • , M. Alcantara
  • , V. Cravo
  • , L. Fazzio
  • , A. Felix
  • , M. Iso
  • , C. Musa
  • , A. P. Siciliano
  • , F. Villaca Filho
  • , J. Braga
  • , A. Rodrigues
  • , R. Silva
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  • , Umit Yasar Sinan
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  • , S. Streather
  • , F. Asch
  • , M. Zemedkun
  • , B. Alyavi
  •  & J. Uzokov

Corresponding author

Correspondence to Christine Selton-Suty.

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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

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Supplementary file1 (DOCX 165 KB)

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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

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