Why the study?
Considerable uncertainty surrounds embolic events in infective endocarditis, predicting them remains incompletely understood, and indications for cardiac surgery solely to prevent embolic events remain controversial.
Does cardiac surgery prevent embolic events in patients with infective endocarditis in the absence of heart failure or uncontrolled infection?
Does cardiac surgery prevent embolic events in patients with infective endocarditis in the absence of heart failure or uncontrolled infection?
This review highlights the uncertainty and controversial evidence surrounding the use of cardiac surgery solely to prevent embolic events in infective endocarditis.
Embolic events in IE warrant vigilant monitoring for hemorrhagic risk; review leaves open optimal preventive strategies.
Infective endocarditis (IE) is a life-threating entity with three main complications: heart failure (HF), uncontrolled infection (UI) and embolic events (EEs). HF and UI are the main indications of cardiac surgery and have been studied thoroughly. On the other hand, much more uncertainty surrounds EEs, which have an abrupt and somewhat unpredictable behaviour. EEs in the setting of IE have unique characteristics that must be explored, such as the potential of hemorrhagic transformation of stroke. Accurately predicting which patients will suffer EEs seems to be pivotal to achieve an optimal management of the disease, but this complex process is still not completely understood. The indication of cardiac surgery in order to prevent EEs in the absence of HF or UI is in question as scientific evidence is controversial and mainly of a retrospective nature. This revision addresses these topics and try to summarize the evidence and recommendations about them.
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Villalba et al. (2024) studied this question.