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Surgery for left-sided native valve endocarditis

Daniel J Sexton, MD
Rakesh M Suri, MD, DPhil
Section Editors
Scott E Kasner, MD
Catherine M Otto, MD
William H Gaasch, MD
Deputy Editors
Susan B Yeon, MD, JD, FACC
Elinor L Baron, MD, DTMH


Since the 1960s, valve replacement and valve repair have become common procedures for management of selected cases of infective endocarditis (IE). A review found that a mean of 32 percent of IE patients in published studies underwent valve surgery [1].  

The indications for, efficacy of, and considerations for surgery in the setting of left-sided native valve endocarditis will be reviewed here. The medical treatment of native valve endocarditis, management of right-sided endocarditis, and the role of surgery in prosthetic valve endocarditis are discussed separately. (See "Antimicrobial therapy of native valve endocarditis" and "Infective endocarditis in injection drug users" and "Surgery for prosthetic valve endocarditis".)


Management of patients with infective endocarditis (IE) includes determination of whether surgical treatment is indicated. Among patients with IE with indications for surgery, there is generally no benefit from delay. An exception applies to patients with hemorrhagic stroke and possibly also to patients with severe stroke. Among patients referred for valve surgery (particularly mitral), valve repair is generally preferred to valve replacement.

Determination of whether a patient with IE requires surgical treatment depends upon many clinical and prognostic factors [2]. Patients with IE are best managed by a multispecialty heart valve team that includes an infectious disease specialist, cardiologist, and cardiac surgeon [2-5]. Prompt surgical consultation is warranted in all patients with IE as indications for surgical intervention may appear suddenly and decisions about the timing of surgery in patients with indications for surgery are often complex.

Indications — Early surgery (ie, during initial hospitalization and before completion of a full course of antibiotics) is indicated in patients with left-sided native valve IE and one or more of the following features [2-4]:


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Literature review current through: Feb 2017. | This topic last updated: Tue Nov 03 00:00:00 GMT 2015.
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