Age differences in mortality in patients undergoing surgery for infective endocarditis

Abstract Background Infective endocarditis (IE) is associated with high mortality. Surgery may improve survival, but the intercept between benefit and harm is hard to balance and may be closely related to age. Purpose To examine the in-hospital and 90-day mortality in patients undergoing surgery for IE and to identify differences between age groups and type of valvular intervention. Methods By crosslinking nationwide Danish registries we identified patients with first-time IE undergoing surgical treatment in the period from 2000 to 2017. The study population was grouped in patients <60 years, 60–75 years, and ≥75 years of age. High-risk subgroups by age and surgical valve intervention (mitral vs aortic vs mitral+aortic) during IE admission were examined. Kaplan Meier estimates was used to identify 90-day mortality by age groups and multivariable adjusted Cox proportional hazard analysis was used to examine factors associated with 90-day mortality. Results We included 1,767 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 proportion of patients with IE undergoing surgery was 35.3%, 26.9%, and 9.1% for patients <60 years, 60–75 years, and >75 years, respectively. For patients with IE undergoing surgery, the in-hospital mortality was 6.4%, 13.6%, and 20.3% for patients <60 years, 60–75 years, and ≥75 years of age, respectively and mortality at 90 days were 7.5%, 13.9%, and 22.3%, respectively. Factors associated with an increased risk 90-day mortality were: mitral valve surgery and a combination of mitral and aortic valve surgery as compared with isolated aortic valve surgery, patients 60–75 years and >75 years as compared with patients aged <60 years, prosthetic heart valve prior to IE admission, and diabetes, Figure. Patients >75 years undergoing a combination of mitral and aortic valve surgery had an in-hospital mortality of 36.3%. Conclusion In patients undergoing surgery for IE, a stepwise increase in 90-day mortality was seen for age groups, highest among patients >75 years with a 90-day mortality of more than 20%. Patients undergoing mitral and combined mitral and aortic valve surgery as compared to isolated aortic valve surgery were associated with a higher mortality. These findings may be of importance for the management strategy of patients with IE. Mortality risk Funding Acknowledgement Type of funding source: None

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Differences in mortality in patients undergoing surgery for infective endocarditis according to age and valvular surgery

BMC Infectious Diseases ◽

10.1186/s12879-020-05422-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Lauge Østergaard ◽

Morten Holdgaard Smerup ◽

Kasper Iversen ◽

Andreas Dalsgaard Jensen ◽

Anders Dahl ◽

...

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Aortic Valve ◽

Surgical Intervention ◽

Prosthetic Heart Valve ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Factors Associated ◽

Valvular Surgery

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.

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New Trends in Aortic Valve Surgery: A critical Review of Standard Prosthesis v. Stentless Replacement and Repair

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239400200202 ◽

1994 ◽

Vol 2 (2) ◽

pp. 69-74

Author(s):

Carlos MG Duran ◽

Begonia Gometza ◽

Fareed Khouqeer ◽

Ali Al-Sanei ◽

Zohair Al-Halees

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Hospital Mortality ◽

Valve Replacement ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Mechanical Prosthesis ◽

Actuarial Survival ◽

Group I ◽

Repair Group

Different alternatives for the surgical treatment of aortic valve disease have been recently introduced. All consecutive patients who underwent aortic valve surgery between July 1988 and March 1994 were reviewed. There were 674 patients with a mean age of 32.4 years, mean preoperative functional class of 2.82, and rheumatic etiology in 59% of the cases. The patients were divided into 3 groups: Group I. standard aortic valve replacement with biological and mechanical prosthesis ( n = 313); Group II. stentless aortic valve replacement using homograft, pulmonary autograft and reconstruction with pericardium ( n = 145); and Group HI. aortic valve repair ( n = 216). The hospital mortality was 6.07% for the standard, 0.68% for the stentless, and 3.70% for the repair. Total follow-up was 1,304.75 patient years with a mean of 21.93 months. The actuarial survival at 66 months excluding hospital mortality was 85.24 ± 4.59% in the standard replacement, 92.63 ± 4.03% in the stentless, and 91.20 ± 3.02% in the repair group. The highest incidence of reoperation corresponded to the repair group with an actuarial freedom from reoperation of 74.26 ±7.03%, v. 92.52 ±4.52% in the standard and 85.11 ± 6.71% in the stentless group. There were no thromboembolic events in the isolated aortic valve survivors in both the stentless and repair groups and 1.28% patient years in the standard. We conclude that both the stentless aortic valve replacement and the aortic repair represent a good alternative v. standard replacement, especially for those young rheumatic patients in which anticoagulation and durability of the prosthesis is still a problem.

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Effect of Publicly Reported Aortic Valve Surgery Outcomes on Valve Surgery in Injection Drug– and Non–Injection Drug–Associated Endocarditis

Clinical Infectious Diseases ◽

10.1093/cid/ciz834 ◽

2019 ◽

Vol 71 (3) ◽

pp. 480-487

Author(s):

Simeon D Kimmel ◽

Alexander Y Walley ◽

Benjamin P Linas ◽

Bindu Kalesan ◽

Eric Awtry ◽

...

Keyword(s):

Aortic Valve ◽

Hospital Mortality ◽

Valve Replacement ◽

International Classification Of Diseases ◽

Public Reporting ◽

Valve Surgery ◽

Injection Drug ◽

Aortic Valve Surgery ◽

Interrupted Time Series Analysis ◽

Patient Death

Abstract Background Injection drug use–associated infective endocarditis (IDU-IE) is rising and valve surgery is frequently indicated. The effect of initiating public outcomes reporting for aortic valve surgery on rates of valve surgery and in-hospital mortality for endocarditis is not known. Methods For an interrupted time series analysis, we used data from the National Inpatient Sample, a representative sample of United States inpatient hospitalizations, from January 2010 to September 2015. We included individuals aged 18–65 with an International Classification of Diseases, Ninth Revision (ICD-9) diagnosis of endocarditis. We defined IDU-IE using a validated combination of ICD-9 codes. We used segmented logistic regression to assess for changes in valve replacement and in-hospital mortality rates after the public reporting initiation in January 2013. Results We identified 7322 hospitalizations for IDU-IE and 23 997 for non–IDU-IE in the sample, representing 36 452 national IDU-IE admissions and 119 316 non-IDU admissions, respectively. Following the implementation of public reporting in 2013, relative to baseline trends, the odds of valve replacement decreased by 4.0% per quarter (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.93–0.99), with no difference by IDU status. The odds of an in-patient death decreased by 2.0% per quarter for both IDU-IE and non–IDU-IE cases following reporting (OR 0.98, 95% CI 0.97–0.99). Conclusions Initiating public reporting was associated with a significant decrease in valve surgery for all IE cases, regardless of IDU status, and a reduction in-hospital mortality for patients with IE. Patients with IE may have less access to surgery as a consequence of public reporting. To understand how reduced valve surgery impacts overall mortality, future studies should examine the postdischarge mortality rate.

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