Evaluating Treatment Options for Patients With Infective Endocarditis

When Is It the Right Time for Surgery?

Aneil Malhotra; Bernard D Prendergast


Future Cardiol. 2012;8(6):847-861. 

In This Article

Indications for Surgery

The indications for surgery in IE have increased over time. It is important to consider early surgical intervention in active IE to avoid progression to heart failure, irreversible structural damage and systemic embolism. The European Society of Cardiology published guidelines on the prevention and treatment of IE in 2009,[5] including helpful recommendations concerning the timing of surgery – the indications for surgery in these guidelines closely resemble those recommended by The American College of Cardiology/American Heart Association.[6]

The general consensus is that surgery is warranted for patients with active native IE who have one or more of the following:

  • Congestive cardiac failure (CCF) directly related to valvular dysfunction;

  • Uncontrolled infection secondary to persistent sepsis, perivalvular infection with abscess, fistula or pseudoaneursym formation or resistant pathogens;

  • Systemic embolism.

Figure 1 & Table 2 summarize the indications for surgery and its timing in native valve endocarditis as recommended by the European Society of Cardiology.[5,32]

Figure 1.

Surgical indications in native valve infective endocarditis.
Surgery is considered if previous embolism and persistent vegetations. Surgery can also be considered if isolated very large vegetations (>15 mm) are present, especially if conservative surgery is feasible.
Adapted with permission from [32].