Emergency Management of Infective Endocarditis
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Cardiac surgery is required in more than 50% of patients with active infective endocarditis. Patients should be referred to an expert center for rapid evaluation. Surgical indication and timing have to be defined by an endocarditis team. Early surgery is beneficial not only in the absence of cerebral complications but also in patients with cerebral infarction without coma. Management of patients with intracranial hemorrhage remains very complex, but surgery may be performed within the first month after hemorrhagic stroke in selected patients if there is a strong indication for early surgery. The aim of surgery is (a) to eradicate the infection removing all the infected structures and materials, (b) to allow a bacteriological diagnosis, and (c) to perform an anatomical reconstruction of affected structures.
The use of foreign materials should be kept to a minimum, reducing the incidence of recurrent infection. Valve repair is preferable to valve replacement, and when a durable valve repair is not feasible, a tailored approach for each patient and the clinical situation should be recommended for the choice of the valve substitute.
KeywordsInfective endocarditis Blood culture Abscess Prosthetic valve Echocardiography Anti-infective agents Endocarditis team Surgery
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