Infective endocarditis in octogenarians-a multicenter analysis†.

Objectives: In an older population, infective endocarditis (IE) tends to present uniquely. In this study, we investigate the clinical presentation, microbiological profile and outcomes of IE in octogenarians.

Methods: This multicentre retrospective analysis includes 4917 consecutive patients suffering from IE. We analysed the data on octogenarians undergoing surgery due to IE. Primary outcomes were 30-day mortality and 5-year survival.

Results: We found 4625 (94.1%) were younger than 80 years old, whereas 292 patients (5.9%) were octogenarians. The median age of the non-octogenarian cohort was 65 years (54-73 years), whereas the median age of the octogenarian cohort was 82 years (81-84 years). The median EuroSCORE II was 16.5 (9.5-40.4) in the octogenarian group and 9.7 (4.4-21.5) in the non-octogenarian group (P < 0.001). There was a higher number of males in the non-octogenarian group (P < 0.001). Prosthetic valve endocarditis (P < 0.001) and pacemaker endocarditis (P < 0.001) were higher in the octogenarian group. Streptococcal infections were more frequent in octogenarians (P = 0.033), whereas a significantly higher number of non-octogenarians suffered from blood culture negative IE (P = 0.002).The rate of postoperative adverse cerebrovascular events and postoperative morbidities was comparable between the groups. The 30-day mortality was higher in the octogenarian group (P < 0.001). Survival rates at 1 and 5 years were 48% and 39%, respectively, in the octogenarian group (P < 0.001).

Conclusions: IE in the elderly is associated with a higher risk and may present with a different clinical profile. Although advanced age does play a role in the outcomes of surgery for IE, it alone should not be the sole factor to rule out surgery in this cohort.