The decision to pursue surgery for treatment of infective endocarditis is complex and requires a multidisciplinary approach. Early surgery (during hospitalization and before completion of an antimicrobial course) is recommended for patients with (1) symptomatic heart failure and valvular dysfunction; (2) left-sided infective endocarditis caused by fungal infections or highly-resistant organisms; (3) associated complications, such as annular or aortic abscess, destructive penetrating lesions, or heart block; or (4) persistent bacteremia or fevers lasting more than 5 to 7 days despite appropriate antimicrobial therapy. Early surgery is reasonable in patients with recurrent emboli and persistent valve vegetations and may be considered in the presence of a large (>10-mm), left-sided vegetation. When infective endocarditis is associated with a pacemaker or defibrillator, the entire system (generator and leads) must be removed.
Chief Residents' Blog 