When is surgery indicated for the treatment of native valve endocarditis (NVE)?

Updated: Jan 03, 2019
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Approximately 15-25% of patients with IE eventually require surgery.

Indications for surgical intervention in patients with NVE are as follows:

  • Congestive heart failure refractory to standard medical therapy
  • Fungal IE (except that caused by Histoplasma capsulatum)
  • Persistent sepsis after 72 hours of appropriate antibiotic treatment
  • Recurrent septic emboli, especially after 2 weeks of antibiotic treatment
  • Rupture of an aneurysm of the sinus of Valsalva
  • Conduction disturbances caused by a septal abscess
  • Kissing infection of the anterior mitral leaflet in patients with IE of the aortic valve

Congestive heart failure in a patient with NVE is the primary indication for surgery. A second relapse, during or after completion of treatment, requires replacement of the valve.

Paravalvular abscess and intracardiac fistula almost always require surgical intervention. Patients with culture-negative NVE who remained febrile for more than 10 days should be considered surgical candidates. Persistent hypermobile vegetations, especially those with a history of embolization beyond 7 days of antibiotic therapy, should be treated with surgery. Cardiac surgery should be considered in patients with multiresistant organisms (eg, enterococci).

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