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

Postoperative Management

A detailed discussion of postoperative management and follow-up is beyond the scope of this article and is covered in published European guidelines.[90] In the vast majority of patients, antibiotic therapy for 4–6 weeks is recommended, regardless of the timing of surgery. Positive cultures of excised valve tissue usually reflect intended early valve surgery and do not indicate the need for a fresh 6 week course of postoperative antibiotic therapy. If surgery is performed late and valve cultures remain positive, the duration of postoperative treatment should be discussed with the microbiological team and tailored to the individual patient. A postoperative TTE following completion of antibiotic therapy is helpful to confirm cure and provide a baseline measure for long-term follow-up.

Survivors of surgery are a high-risk group for recurrent IE and patients should be made aware of the need to seek early medical advice for fever or other concerning symptoms. Similarly, primary care physicians should be made aware of the need for blood cultures before use of empiric antibiotic therapy. Prosthetic valve IE is potentially avoidable and patient education regarding the importance of dental and skin hygiene, avoidance of unnecessary medical instrumentation (e.g., intravenous cannulae, urinary catheterization) and use of antibiotic prophylaxis at the time of invasive procedures is essential in this group.