Infective endocarditis – surgical treatment in subjects 65 years old and older

Stanislaw Ostrowski, Janusz Zaslonka, Alicja Iwaszkiewicz, Anna Kosmider, Michal Wojciechowski, Slawomir Jander, Radoslaw Zwolinski, Leszek Markuszewski, Andrzej Walczak

Summary
Background: The objective of the study was to evaluate the results of surgical treatment of infective endocarditis in patients aged 65 and more who underwent operation in the Department of Cardiac Surgery, Medical University of Lodz, in 2001 and 2002.
Material and methods: Among all 31 patients operated on during this period, 23% were aged 65 and more (3 men and 4 women). In 2 cases infective endocarditis was associated with a prosthetic valve. Negative blood culture was present in 5 patients. Every patient had undergone at least one cycle of antibiotic therapy before the intervention. Four patients were in the NYHA III/IV functional class before surgery, and one had had an ischaemic stroke. Transoesophageal echocardiography was used as the main diagnostic method.
Results: After surgery, low cardiac output syndrome developed in 3 patients, resulting in 2 deaths (29% compared to 20% mortality rate in patients aged less than 65).
Conclusions: Cardiac surgery in infective endocarditis is very risky, irrespective of age, especially in patients having already had valve prosthesis, when a possibility of a redo operation must be considered. Higher mortality in the elderly is due to their general condition. In these patients many other causes are suspected of contributing the general deterioration in condition which delays the correct treatment.

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