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Does Age Influence the Preoperative Condition and, Thus, the Outcome in Endocarditis Patients?

Background: Demographic changes have led to an increase in the proportion of older patients undergoing heart surgery. The number of endocarditis cases is also steadily increasing. Given the sharp increase in patients who have received valve prostheses or electrophysiological implants, who are on chr...

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Autores principales: Ostovar, Roya, Zinab, Farzaneh Seifi, Schröter, Filip, Hartrumpf, Martin, Fritzsche, Dirk, Albes, Johannes Maximilian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9918276/
https://www.ncbi.nlm.nih.gov/pubmed/36769471
http://dx.doi.org/10.3390/jcm12030822
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author Ostovar, Roya
Zinab, Farzaneh Seifi
Schröter, Filip
Hartrumpf, Martin
Fritzsche, Dirk
Albes, Johannes Maximilian
author_facet Ostovar, Roya
Zinab, Farzaneh Seifi
Schröter, Filip
Hartrumpf, Martin
Fritzsche, Dirk
Albes, Johannes Maximilian
author_sort Ostovar, Roya
collection PubMed
description Background: Demographic changes have led to an increase in the proportion of older patients undergoing heart surgery. The number of endocarditis cases is also steadily increasing. Given the sharp increase in patients who have received valve prostheses or electrophysiological implants, who are on chronic dialysis or taking immunosuppressants, the interdependence of these two developments is quite obvious. We have studied the situation of older patients suffering from endocarditis compared to younger ones. Are they more susceptible, and are there differences in outcomes? Patients and Methods: A total of 162 patients was studied from our database, enrolled from 2020 to 2022. Fifty-four of them were older than 75 years of age (mean age 79.9 ± 3.8 years). The remaining 108 patients had a mean age of 61.6 ± 10.1 years. EuroSCORE II (ES II) was higher in the older patients (19.3 ± 19.7) than in the younger ones (13.2 ± 16.84). The BMI was almost identical. The preoperative NYHA proportions did not differ. A statistical analysis was performed using R. Results: Older patients had a lower left ventricular ejection fraction (LVEF), a higher proportion of coronary heart disease (CHD), a higher amount of N-terminal probrain natriuretic peptides (NT-proBNPs), worse coagulation function, worse renal function than younger patients, and were more often valve prosthesis carriers compared to the younger patients. The diagnostic interval was 66.85 ± 49.53 days in the younger cohort, whereas it was only 50.98 ± 30.55 in the elderly (p = 0.081). Significantly fewer septic emboli were observed in the older patients than in the younger patients, but postoperative delirium and critical illness polyneuropathy and critical illness myopathy (CIP/CIM) were observed significantly more frequently compared to younger patients. In-hospital mortality was higher in older patients than in younger patients, but did not reach statistical significance (29.91% vs. 40.38%; p = 0.256). The postoperative clinical status was worse in older patients than in the younger ones (NYHA-stage, p = 0.022). Conclusions: Age did have an impact on the outcome, probably due to causing a higher number of cumulative preoperative risk factors. However, an interesting phenomenon was that older patients had fewer septic emboli than younger patients. It can only be speculated whether this was due to a shorter diagnostic interval or lower mobility, i.e., physical exertion. Older patients suffered more frequently than younger ones from typical age-related postoperative complications, such as delirium and CIP/CIM. In-hospital mortality was high, but not significantly higher compared to the younger patients. Considering the acceptable mortality risks, and in light of the lack of alternatives, older patients should not be denied surgery. However, individual consideration is necessary.
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spelling pubmed-99182762023-02-11 Does Age Influence the Preoperative Condition and, Thus, the Outcome in Endocarditis Patients? Ostovar, Roya Zinab, Farzaneh Seifi Schröter, Filip Hartrumpf, Martin Fritzsche, Dirk Albes, Johannes Maximilian J Clin Med Article Background: Demographic changes have led to an increase in the proportion of older patients undergoing heart surgery. The number of endocarditis cases is also steadily increasing. Given the sharp increase in patients who have received valve prostheses or electrophysiological implants, who are on chronic dialysis or taking immunosuppressants, the interdependence of these two developments is quite obvious. We have studied the situation of older patients suffering from endocarditis compared to younger ones. Are they more susceptible, and are there differences in outcomes? Patients and Methods: A total of 162 patients was studied from our database, enrolled from 2020 to 2022. Fifty-four of them were older than 75 years of age (mean age 79.9 ± 3.8 years). The remaining 108 patients had a mean age of 61.6 ± 10.1 years. EuroSCORE II (ES II) was higher in the older patients (19.3 ± 19.7) than in the younger ones (13.2 ± 16.84). The BMI was almost identical. The preoperative NYHA proportions did not differ. A statistical analysis was performed using R. Results: Older patients had a lower left ventricular ejection fraction (LVEF), a higher proportion of coronary heart disease (CHD), a higher amount of N-terminal probrain natriuretic peptides (NT-proBNPs), worse coagulation function, worse renal function than younger patients, and were more often valve prosthesis carriers compared to the younger patients. The diagnostic interval was 66.85 ± 49.53 days in the younger cohort, whereas it was only 50.98 ± 30.55 in the elderly (p = 0.081). Significantly fewer septic emboli were observed in the older patients than in the younger patients, but postoperative delirium and critical illness polyneuropathy and critical illness myopathy (CIP/CIM) were observed significantly more frequently compared to younger patients. In-hospital mortality was higher in older patients than in younger patients, but did not reach statistical significance (29.91% vs. 40.38%; p = 0.256). The postoperative clinical status was worse in older patients than in the younger ones (NYHA-stage, p = 0.022). Conclusions: Age did have an impact on the outcome, probably due to causing a higher number of cumulative preoperative risk factors. However, an interesting phenomenon was that older patients had fewer septic emboli than younger patients. It can only be speculated whether this was due to a shorter diagnostic interval or lower mobility, i.e., physical exertion. Older patients suffered more frequently than younger ones from typical age-related postoperative complications, such as delirium and CIP/CIM. In-hospital mortality was high, but not significantly higher compared to the younger patients. Considering the acceptable mortality risks, and in light of the lack of alternatives, older patients should not be denied surgery. However, individual consideration is necessary. MDPI 2023-01-19 /pmc/articles/PMC9918276/ /pubmed/36769471 http://dx.doi.org/10.3390/jcm12030822 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Ostovar, Roya
Zinab, Farzaneh Seifi
Schröter, Filip
Hartrumpf, Martin
Fritzsche, Dirk
Albes, Johannes Maximilian
Does Age Influence the Preoperative Condition and, Thus, the Outcome in Endocarditis Patients?
title Does Age Influence the Preoperative Condition and, Thus, the Outcome in Endocarditis Patients?
title_full Does Age Influence the Preoperative Condition and, Thus, the Outcome in Endocarditis Patients?
title_fullStr Does Age Influence the Preoperative Condition and, Thus, the Outcome in Endocarditis Patients?
title_full_unstemmed Does Age Influence the Preoperative Condition and, Thus, the Outcome in Endocarditis Patients?
title_short Does Age Influence the Preoperative Condition and, Thus, the Outcome in Endocarditis Patients?
title_sort does age influence the preoperative condition and, thus, the outcome in endocarditis patients?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9918276/
https://www.ncbi.nlm.nih.gov/pubmed/36769471
http://dx.doi.org/10.3390/jcm12030822
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