Ostovar Roya, Zinab Farzaneh Seifi, Schröter Filip, Hartrumpf Martin, Fritzsche Dirk, Albes Johannes Maximilian
Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg Medical School, Faculty of Health Sciences Brandenburg, 16321 Bernau, Germany.
Department of Cardiac Surgery, Sana-Heart Center Cottbus, 03048 Cottbus, Germany.
J Clin Med. 2023 Jan 19;12(3):822. doi: 10.3390/jcm12030822.
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? 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. 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 ( = 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%; = 0.256). The postoperative clinical status was worse in older patients than in the younger ones (NYHA-stage, = 0.022). 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.
人口结构的变化导致接受心脏手术的老年患者比例增加。心内膜炎病例数量也在稳步上升。鉴于接受瓣膜假体或电生理植入物、进行慢性透析或服用免疫抑制剂的患者急剧增加，这两种情况之间的相互依存关系非常明显。我们研究了老年心内膜炎患者与年轻患者相比的情况。他们是否更易感染，以及预后是否存在差异？我们从2020年至2022年的数据库中选取了162例患者进行研究。其中54例年龄超过75岁（平均年龄79.9±3.8岁）。其余108例患者的平均年龄为61.6±10.1岁。老年患者的欧洲心脏手术风险评估系统II（ES II）（19.3±19.7）高于年轻患者（13.2±16.84）。体重指数几乎相同。术前纽约心脏协会（NYHA）分级比例无差异。使用R软件进行统计分析。与年轻患者相比，老年患者的左心室射血分数（LVEF）较低、冠心病（CHD）比例较高、N末端脑钠肽前体（NT-proBNPs）水平较高、凝血功能较差、肾功能较差，且瓣膜假体携带者更为常见。年轻队列的诊断间隔为66.85±49.53天，而老年患者仅为50.98±30.55天（P=0.081）。老年患者观察到的脓毒性栓子明显少于年轻患者，但术后谵妄、危重病多神经病和危重病肌病（CIP/CIM）的发生率明显高于年轻患者。老年患者的院内死亡率高于年轻患者，但未达到统计学意义（29.91%对40.38%；P=0.256）。老年患者术后的临床状况比年轻患者差（NYHA分级，P=0.022）。年龄确实对预后有影响，可能是由于术前累积风险因素较多。然而，一个有趣的现象是老年患者的脓毒性栓子比年轻患者少。只能推测这是由于诊断间隔较短还是活动能力较低，即体力活动较少。老年患者比年轻患者更频繁地遭受典型的与年龄相关的术后并发症，如谵妄和CIP/CIM。院内死亡率较高，但与年轻患者相比并非显著更高。考虑到可接受的死亡风险，并且鉴于缺乏其他选择，不应拒绝老年患者进行手术。然而，需要进行个体评估。
