title: Surgical treatment for infective endocarditis in elderly patients.
abstract: OBJECTIVE
  We evaluate the clinical, echographic and prognostic characteristics of infective endocarditis (IE) in a large population of elderly patients, and the results of surgical approach.
  
  
  METHODS
  Multicentric, prospective, observational cohort study with 961 consecutive left-sided IE: 356 patients aged ≥65 years were compared with 605 younger. Indications for cardiac surgery, potential surgical risk, time and outcome, were compared.
  
  
  RESULTS
  Hospital-acquired endocarditis, comorbidity, renal failure and septic shock were more frequent in elderly, but embolisms were less. Intracardiac destruction and ventricular failure were similar in both groups, but significantly fewer elderly patients underwent cardiac surgery (36% vs 51%; p < 0.01), and this group showed a worse outcome (43.2% of mortality vs 27% in younger; p < 0.01), resulting age as an independent predictor of mortality (OR: 1.02 CI95%: 1.01-1.03). Compared with medical treatment, surgery showed lower percentages of mortality compared with medical treatment (23.3% vs 31.3%; p = 0.03) in younger group, but a high mortality was observed with both procedures (47.6% vs 40.3%; p = 0.1) in the elderly.
  
  
  CONCLUSIONS
  Although similar percentages of heart failure and intracardiac complications, increasing age is associated with higher mortality in IE. Lower rates of surgical treatment and a worse outcome after operation are common features in elderly patients.
authors.affiliation: Hospital Virgen del Rocío, Avda Manuel Siurot s/n, 41013 Sevilla, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Ramírez-Duque
authors.forename: E
authors.initials: E
authors.lastname: García-Cabrera
authors.forename: R
authors.initials: R
authors.lastname: Ivanova-Georgieva
authors.forename: M
authors.initials: M
authors.lastname: Noureddine
authors.forename: J M
authors.initials: JM
authors.lastname: Lomas
authors.forename: C
authors.initials: C
authors.lastname: Hidalgo-Tenorio
authors.forename: A
authors.initials: A
authors.lastname: Plata
authors.forename: J
authors.initials: J
authors.lastname: Gálvez-Acebal
authors.forename: J
authors.initials: J
authors.lastname: Ruíz-Morales
authors.forename: J
authors.initials: J
authors.lastname: de la Torre-Lima
authors.forename: J M
authors.initials: JM
authors.lastname: Reguera
authors.forename: F J
authors.initials: FJ
authors.lastname: Martínez-Marcos
authors.forename: A
authors.initials: A
authors.lastname: de Alarcón
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004696:Endocarditis / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult