Differences in mortality in patients undergoing surgery for infective endocarditis according to age and valvular surgery
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RESEARCH ARTICLE
Open Access
Differences in mortality in patients undergoing surgery for infective endocarditis according to age and valvular surgery Lauge Østergaard1* , Morten Holdgaard Smerup1, Kasper Iversen2, Andreas Dalsgaard Jensen1, Anders Dahl2, Sandra Chamat-Hedemand2, Niels Eske Bruun3,4,5, Jawad Haider Butt1, Henning Bundgaard1, Christian Torp-Pedersen6,7, Lars Køber1 and Emil Fosbøl1
Abstract Background: Infective endocarditis (IE) is associated with high mortality. Surgery may improve survival and reduce complications, but the balance between benefit and harm is difficult and may be closely related to age and type of surgical intervention. We aimed to examine how age and type of left-sided surgical intervention modified mortality in patients undergoing surgery for IE. Methods: By crosslinking nationwide Danish registries we identified patients with first-time IE undergoing surgical treatment 2000–2017. Patients were grouped by age < 60 years, 60–75 years, and ≥ 75 years. Multivariable adjusted Cox proportional hazard analysis was used to examine factors associated with 90-day mortality. Results: We included 1767 patients with IE undergoing surgery, 735 patients < 60 years (24.1% female), 766 patients 60–75 years (25.8% female), and 266 patients ≥75 years (36.1% female). The proportions of patients undergoing surgery were 35.3, 26.9, and 9.1% for patients < 60 years, 60–75 years, and > 75 years, respectively. Mortality at 90 days were 7.5, 13.9, and 22.3% (p < 0.001) for three age groups. In adjusted analyses, patients 60–75 years and patients ≥75 years were associated with a higher mortality, HR = 1.84 (95% CI: 1.48–2.29) and HR = 2.47 (95% CI: 1.88–3.24) as compared with patients < 60 years. Factors associated with 90-day mortality were: mitral valve surgery, a combination of mitral and aortic valve surgery as compared with isolated aortic valve surgery, age, diabetes, and prosthetic heart valve implantation prior to IE admission. Conclusions: In patients undergoing surgery for IE, mortality increased significantly with age and 1 in 5 died above age 75 years. Mitral valve surgery as well as multiple valve interventions augmented mortality further. Keywords: Infective endocarditis, Cardiac surgery, Endocarditis
Background Infective endocarditis (IE) remains a disease with an inhospital mortality around 20% [1–3] and several studies have suggested that the incidence of IE is increasing * Correspondence: [email protected] 1 The Heart Center, Rigshospitalet, Copenhagen, Denmark Full list of author information is available at the end of the article
especially among patients aged > 75 years [2, 4–7]. It has been reported that surgery is performed in 23–52% of patients with IE from population-based cohorts [5, 8– 10], however surgery in elderly patients may be challenging due to the burden of comorbidities and high perioperative risk. Several studies have described temporal changes of the epidemiologic characteristics of patients
© The Author(s). 2020 Open Access This article is licensed under
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