The Mortality of Infective endocarditis with and without Surgery in Elderly (MoISE) Study

Abstract

Background Infective endocarditis (IE) is increasingly affecting older patients, but data on their management are sparse and the benefits of surgery in this population are unclear. Methods We included patients with left-sided IE (LSIE) aged ≥ 80 years enrolled in a prospective endocarditis cohort managed in Aquitaine, France from 2013 to 2020. Geriatric data were collected retrospectively to identify factors associated with the 1-year risk of death using Cox regression. Results We included 163 patients with LSIE (median age, 84 years; men, 59%; rate of prosthetic LSIE, 45%). Of the 105 (64%) patients with potential surgical indications, 38 (36%) underwent valve surgery: they were younger, more likely to be men with aortic involvement, and had a lower Charlson Comorbidity Index. Moreover, they had better functional status at admission (i.e., the ability to walk unassisted and a higher median Activities of Daily Living [ADL] score [n = 5/6 vs. 3/6, p = 0.01]). The 1-year mortality rate in LSIE patients without surgical indications was 28%; it was lower in those who were operated on compared to those who were not despite a surgical indication (16% vs. 66%, p < 0.001). Impaired functional status at admission was strongly associated with mortality regardless of surgical status. In patients unable to walk unassisted or with an ADL score < 4, there was no significant surgical benefit for 1-year mortality. Conclusion Surgery improves the prognosis of older patients with LSIE and good functional status. Surgical futility should be discussed in patients with altered autonomy. The endocarditis team should include a geriatric specialist.

Impact of valvular surgery according to frailty risk in patients with infective endocarditis

“…The increasing prevalence of comorbidities in patients with IE makes it necessary to consider the role of treatment indications and the expected benefit of invasive interventions such as cardiac surgery, which is still controversial in many cases. 3 , 12 , 14 , 15 A high degree of comorbidity has led to a lower indication for surgery, especially in older patients. 3 As expected, comorbidities were higher in patients with intermediate and high frailty risk, and those with high frailty risk were older.…”

“…The proportion of women was similar in the three frailty states (around 40%), but was significantly lower in the group of patients undergoing valve surgery for IE, which has also been documented in previous studies. 15 , 17 , 18 , 19 …”

“…We found a lower frequency of patients undergoing cardiac surgery compared to other series. 3 , 15 However, it is important to note that this is a national administrative database with a very large number of cases (>50 000) and that previous registries probably did not include cases of lesser severity that were managed differently, outpatient or in less complex centers.…”

“…In a previous study, Hémar V et al found that poor functional status in elderly patients predicted mortality in those undergoing surgery. In this sense, it would be important to individualize each case, because in fact the highest mortality in this cohort of patients occurred in the group of patients who did not undergo valvular surgery 15 . In addition, the functional status of patients may be improved through targeted interventions such as rehabilitation, nutrition and other comprehensive geriatric care.…”

Infective Endocarditis Caused by Corynebacterium striatum: Navigating Challenges and Treatment Strategies in an Emerging Threat

“…However, it can also manifest in cases involving native valves [ 9 ]. Like other bacteria, the mortality rate linked to corynebacterial endocarditis ranges from 31% to 43% [ 9 , 10 ]. It is worth mentioning that endocarditis caused by C. striatum has the highest probability of survival compared to other types of Corynebacterium endocarditis [ 11 ].…”