Surgery may be required to address valve damage, uncontrolled infection or embolic risk in infective endocarditis.
Indications for surgery
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Heart failure due to valve damage is an indication for surgery.
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Failure of antibiotic therapy with persistent or uncontrolled infection is an indication.
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Large vegetations on left-sided valves warrant surgery when their echocardiographic appearance suggests a high risk of emboli.
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Previous systemic emboli and abscess formation are additional indications.
Patients and operative management
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Patients with prosthetic valve endocarditis or fungal endocarditis often require cardiac surgery.
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Debridement of infected material and valve replacement may be required in a substantial proportion of patients, particularly with Staphylococcus aureus or fungal infection.
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Antimicrobial therapy must be started before surgery.