Review articleCurrent best practices and guidelines: Indications for surgical intervention in infective endocarditis☆
Section snippets
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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This work was supported by grants from the Swedish Heart and Lung Foundation and the National Board of Health and Welfare, Sweden.