Surgical intervention within seven days of hospitalization in left-sided infective endocarditis significantly reduced acute cerebrovascular accidents and septic emboli but did not reduce in-hospital mortality.
This review outlines the complications and surgical indications for infective endocarditis, emphasizing its rising incidence and persistently high mortality.
Effect estimate: Surgical intervention within 7 days showed statistically significant reduction in likelihood of acute CVA, peripheral septic emboli, and intracranial/intraspinal abscess but no overall decrease in all-cause in-hospital mortality
Infective endocarditis (IE) is an infection of the endocardial surface of the heart involving native or prosthetic valves, endocardial structures, or intracardiac devices/leads. Unfortunately, incidence has risen in many settings over recent years. Historically, the incidence has been about 3–10 cases for every 100,000 person-years and was elevated to about 13.8 cases per 100,000 person-years in 2019. Despite advancements in both detection and treatment, mortality remains high, seen with inpatient mortality rates of 18%, along with a 6-month mortality rate of 30%. IE can be a fatal condition if left untreated, in part due to the multiple serious complications that can arise. By anticipating certain complications, clinicians can be better prepared to treat patients with this condition. This article provides an integrative review of the potential complications of IE. These complications vary depending on whether the patient has native or prosthetic valves. There are cardiac, embolic, and immune-complex mediated complications that can occur. Ultimately, IE can lead to multiorgan dysfunction and result in septic shock and disseminated intravascular coagulopathy (DIC). While the mainstay of treatment for IE remains medical, certain cases require surgical intervention. Due to their close relationship, a review of the indications for surgery in the treatment of IE is also presented in this article. By having a general scope of the complications of IE and when to get a surgical consult, clinicians can be better equipped to care for patients with a potentially fatal condition that is becoming increasingly more frequent.
Bishev et al. (2026) conducted a review in Adults with infective endocarditis involving native or prosthetic valves and intracardiac devices, typical western populations with mean age around 67 years, mostly male. Surgical intervention in infective endocarditis vs. Medical therapy alone was evaluated on Mortality and complications (acute cerebrovascular accidents, peripheral septic emboli, intracranial or intraspinal abscess) after surgical intervention vs medical therapy (Surgical intervention within 7 days showed statistically significant reduction in likelihood of acute CVA, peripheral septic emboli, and intracranial/intraspinal abscess but no overall decrease in all-cause in-hospital mortality). Surgical intervention within seven days of hospitalization in left-sided infective endocarditis significantly reduced acute cerebrovascular accidents and septic emboli but did not reduce in-hospital mortality.