Infective endocarditis (IE) is increasingly affecting older patients, but data on their management are sparse and the benefits of surgery in this population are unclear. We included patients with left-sided IE (LSIE) aged ≥ 80 years enrolled in a prospective endocarditis cohort managed in Aquitaine, France from 2013 to 2020. Geriatric data were collected retrospectively to identify factors associated with the 1-year risk of death using Cox regression. We included 163 patients with LSIE (median age, 84 years; men, 59%; rate of prosthetic LSIE, 45%). Of the 105 (64%) patients with potential surgical indications, 38 (36%) underwent valve surgery: they were younger, more likely to be men with aortic involvement, and had a lower Charlson Comorbidity Index. Moreover, they had better functional status at admission (i.e., the ability to walk unassisted and a higher median Activities of Daily Living [ADL] score [n = 5/6 vs. 3/6, p = 0.01]).The 1-year mortality rate in LSIE patients without surgical indications was 28%; it was lower in those who were operated on compared to those who were not despite a surgical indication (16% vs. 66%, p < 0.001). Impaired functional status at admission was strongly associated with mortality regardless of surgical status. In patients unable to walk unassisted or with an ADL score < 4, there was no significant surgical benefit for 1-year mortality. Surgery improves the prognosis of older patients with LSIE and good functional status. Surgical futility should be discussed in patients with altered autonomy. The endocarditis team should include a geriatric specialist.Read less <