Table 1

Indications for surgery in patients with infective endocarditis²

Indication	Evidence
A: Strong evidence or general agreement that cardiac surgery is useful and effective; B: Inconclusive or conflicting evidence or a divergence of opinion about the usefulness/efficacy of cardiac surgery, but weight of evidence/opinion of the majority is in favour; C: Inconclusive or conflicting evidence or a divergence of opinion; lack of clear consensus on the basis of evidence/opinion of the majority.
AR, aortic regurgitation; MR, mitral regurgitation; NYHA, New York Heart Association functional class.
Emergency indication for cardiac surgery (same day)
Acute AR with early closure of mitral valve	A
Rupture of a sinus Valsalva aneurysm into a right heart chamber	A
Rupture into the pericardium	A
Urgent indication for cardiac surgery (within 1–2 days)
Valvar obstruction	A
Unstable prosthesis	A
Acute AR or MR with heart failure, NYHA III–IV	A
Septal perforation	A
Evidence of annular or aortic abscess, sinus or aortic true or false aneurysm, fistula formation, or new onset conduction disturbances	A
Major embolism+mobile vegetation >10 mm+appropriate antibiotic treatment <7–10 days	B
Mobile vegetation >15 mm+appropriate antibiotic therapy <7–10 days	C
No effective antimicrobial treatment available	A
Elective indication for cardiac surgery (earlier is usually better)
Staphylococcal prosthetic valve infective endocarditis	B
Early prosthetic valve infective endocarditis (⩽2 months after surgery)	B
Evidence of progressive paravalvar prosthetic leak	A
Evidence of valve dysfunction and persistent infection after 7–10 days of appropriate antibiotic treatment, as indicated by presence of fever or bacteraemia, provided there are no non-cardiac causes for infection	A
Fungal infective endocarditis caused by a mould	A
Fungal infective endocarditis caused by a yeast	B
Infection with difficult-to-treat organisms	B
Vegetation growing larger during antibiotic treatment >7 days	C