Review article
Current best practices and guidelines: Indications for surgical intervention in infective endocarditis

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Timing of surgery

The duration of antibiotic therapy before the operation appears to have no influence on operative mortality [9], [10], [11]. It is, however, considered important to have adequate antibiotic coverage during operation to kill bacteria entering the circulation during the surgical debridement. In a Swedish 5-year national study 223 patients underwent cardiac surgery during treatment, one third during the first 5 days and 52% during the first 10 days of treatment. Treatment mortality was equal

Indications for surgery

The indications for surgery are defined more precisely today than in the past [13], [14] due to increased experience and the refinement of echocardiography, particularly the introduction of transesophageal imaging.

Surgery is necessary in approximately 25% to 30% of cases during the acute phase of infection, and in another 20% to 40% in later or secondary phases [18], [19], [20], [21]. In general, the prognosis is better after early surgery undertaken before the cardiac pathology and the general

Neurological complications

Evaluation and management of patients with neurologic symptoms represents another difficult and controversial area. The incidence of neurologic complications differs in the literature from 15% to 40% [11], [46], [48]. Neurologic complications include transient ischemic attack (TIA), embolic stroke with or without hemorrhage, ruptured mycotic aneurysms, meningitis, and non-focal encephalopathy.

The cardiac surgeon has two concerns: the first is related to the immediate risk of intracranial

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References (77)

  • C.H. Croft et al.

    Analysis of surgical versus medical therapy in active complicated native valve endocarditis

    Am J Cardiol

    (1983)
  • J. Mills et al.

    Heart failure in infective endocarditis. Predisposing factors, course and treatment

    Chest

    (1974)
  • G. Pettersson et al.

    The Endocarditis Working Group of the International Society of Chemotherapy. Recommendations for the surgical treatment of endocarditis

    Clin Microbiol Infect

    (1998)
  • B. Omari et al.

    Predictive risk factors for periannular extension of native valve endocarditis: clinical and echocardiographic analyses

    Chest

    (1989)
  • E.A. Blumberg et al.

    Endocarditis-associated paravalvular abscesses: do clinical parameters predict the presence of abscess?

    Chest

    (1995)
  • F.J. Baumgartner et al.

    Annular abscesses in surgical endocarditis: anatomic, clinical, and operative features

    Ann Thorac Surg

    (2000)
  • A.A. Vlessis et al.

    Infective endocarditis: ten-year review of medical and surgical therapy

    Ann Thorac Surg

    (1996)
  • S. De Castro et al.

    Role of transthoracic and transesophageal echocardiography in predicting embolic events with active infective endocarditis involving native cardiac valves

    Am J Cardiol

    (1997)
  • G. Di Salvo et al.

    Echocardiography predicts embolic events in infective endocarditis

    J Am Coll Cardiol

    (2001)
  • S. Heinle et al.

    Value of transthoracic echocardiography in predicting embolic events in active infective endocarditis

    Am J Cardiol

    (1994)
  • G.S. Werner et al.

    Infective endocarditis in the elderly in the era of transesophageal echocardiography: clinical features and prognosis compared with younger patients

    Am J Med

    (1996)
  • S.B. Calderwood et al.

    Prosthetic valve endocarditis. Analysis of factors affecting outcome of therapy

    J Thorac Cardiovasc Surg

    (1986)
  • S.M. Gordon et al.

    Early onset prosthetic valve endocarditis: the Cleveland Clinic experience 1992–1997

    Ann Thorac Surg

    (2000)
  • V.L. Yu et al.

    Prosthetic valve endocarditis: superiority of surgical valve replacement versus medical therapy only

    Ann Thorac Surg

    (1994)
  • F. Jault et al.

    Prosthetic valve endocarditis with ring abscesses. Surgical treatment and long-term results

    J Thorac Cardiovasc Surg

    (1993)
  • S.S. Sett et al.

    Prosthetic valve endocarditis. Experience with bioporcine prosthesis

    J Thorac Cardiovasc Surg

    (1993)
  • K. Eishi et al.

    Surgical management of infective endocarditis associated with cerebral complications. Multi-center retrospective study in Japan

    J Thorac Cardiovasc Surg

    (1995)
  • A.M. Gillinov et al.

    Valve replacements in patients with endocarditis and acute neurologic deficit

    Ann Thorac Surg

    (1996)
  • W. Ting et al.

    Valve replacement in patients with endocarditis and cerebral septic emboli

    Ann Thorac Surg

    (1991)
  • P.E. Parrino et al.

    Does a focal neurologic deficit contraindicate operation in a patient with endocarditis?

    Ann Thorac Surg

    (1999)
  • J.L. Trouillet et al.

    Splenic involvement in infectious endocarditis. Association for the Study and Prevention of Infectious Endocarditis

    Rev Med Interne

    (1999)
  • J. Mathew et al.

    Results of surgical treatment for infective endocarditis in intravenous drug users

    Chest

    (1995)
  • J.H. Kay et al.

    Surgical cure of Candida albicans endocarditis with open-heart surgery

    New Engl J Med

    (1961)
  • A.G. Wallace et al.

    Treatment of acute bacterial endocarditis by valve excision and replacement

    Circulation

    (1965)
  • J.P. Gouello et al.

    Nosocomial endocarditis in the intensive care unit: an analysis of 22 cases

    Crit Care Med

    (2000)
  • L. Olaison et al.

    Early surgery in infective endocarditis

    Q J Med

    (1996)
  • Y. d'Udekem et al.

    Long-term results of surgery for active endocarditis

    Eur J Cardiothorac Surg

    (1997)
  • A.K. Agnihotri et al.

    The prevalence of infective endocarditis after aortic valve replacement

    J Thorac Cardiovasc Surg

    (1995)
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    This work was supported by grants from the Swedish Heart and Lung Foundation and the National Board of Health and Welfare, Sweden.

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