Guidelines for When to Operate in Infective Endocarditis

Abstract

Surgical treatment for Infective Endocarditis comes into play in about half of IE cases due to severe complications. Early surgery hopes to avoid progressive HF, to avoid irreversible structural damage caused by severe infection, and to prevent systemic embolism. The risk of early surgery is the potential risk of postoperative deterioration in unstable patients and of relapse or recurrence if surgery is performed too early, before complete action of antibiotic therapy. The ESC guidelines published in 2009 introduced the notion of optimal timing of surgery, and the 2015 version confirmed the critical importance of optimal timing for surgery. In some cases, surgery needs to be performed on an emergency (within 24 h) or urgent (within a few days) basis, irrespective of the duration of antibiotic treatment, while in other cases, surgery can be postponed to allow for antibiotic treatment under clinical and echocardiographic observation before an elective surgical procedure is performed. The three main indications for early surgery in IE are HF, uncontrolled infection, and prevention of embolic events, and this chapter discusses surgery for these three indications.