Native-Valve Infective Endocarditis — When Does It Require Surgery?

Guidelines, not backed by evidence from randomized trials, strongly recommend urgent surgery for patients with infective endocarditis and congestive heart failure due to valvular regurgitation.1,2 Management algorithms for infective endocarditis have been developed, and a recent study showed that surgery is still required in 50% of patients who receive antibiotics.3 Experience shows that surgery in patients with active infective endocarditis is associated with low mortality.4 Debate continues, however, about the timing of surgery to prevent embolic events when there are large or mobile vegetations or vegetations in particular locations and when patients have severe valve dysfunction but do not . . .