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Left-sided endocarditis (LSE) represents a significant proportion of urgent cardiac surgeries.1 It requires expertise and capabilities for dealing with endocardial and myocardial damages involving all or portion of mitral valve, all or portion of the aortic valve, aortic root and the structures in their anatomical contiguity.2 Literature and guidelines on the management of LSE rely mainly on observational studies, given the challenges associated with the conduct of randomised trials in emergency settings. Endocarditis teams (ETs) are mandatory.3 The role of regular meetings among specialties is fundamental, particularly for frail or extremely sick patients. Decision-making should take into account not only the localisation and the extension of the infection, but also the patient preoperative status and his comorbidities. Previous cardiac surgery, and especially previous valve prosthesis, impact on the prognosis. The best timing is still a matter of debate not only according to the risks but also the feasibility of very early surgery for LSE. Various scores have been developed for preoperative estimates of the mortality associated with cardiac surgeries in different settings.4 5 The ENDOVAL score aims to help and guide the ET for an individualised decision-making process.4 Despite evidence suggests that early surgery may be associated with improved survival in patients with complicated LSE, it also incurred an increased risk of recurrence and postoperative valvular dysfunctions, according to …
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Contributors ED did the first manuscript and got the contribution of EF as a surgeon. PT as an infectiologist and GH as the writer of the guidelines both contributed and provided ideas.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Commissioned; internally peer reviewed.