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Surgery for infective endocarditis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Situations where urgent surgical assessment should be undertaken include (1):

  • persistent pyrexia
  • persistently positive blood cultures
  • new murmurs
  • recurrent emboli despite maximal antimicrobial therapy
  • development of congestive cardiac failure - development of cardiac failure has a mortality of over 50% in patients with infective endocarditis managed with medical treatment alone (1)
  • large vegetations
  • persistent vegetation after a major systemic embolus
  • evidence of an intracardiac abscess
  • worsening renal failure may necessitate consideration of surgical intervention rather than continuation of medical therapy

Absolute indications for surgery include acute valvular regurgitation with pulmonary oedema, dehiscence of a prosthetic valve, and abscess formation (1).

Timing is critical. Ideally, infection should be eliminated beforehand but this has to be balanced against the risk of leaving the heart in a compromised haemodynamic state.

There is a 10 to 25% mortality for patients undergoing surgery during the acute phase.


  1. Drugs and Therapeutics Bulletin (2002). 40 (4), 26-30.

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