Table 1.

Comparison between the 2015 and 2023 ESC guidelines’ recommendations for surgery to prevent emboli [9, 14]

ESC guideline	Surgical indication	Class of recommendation	Level of evidence
2015a
	“Aortic or mitral NVE or PVE with persistent vegetations > 10 mm after one or more embolic episode despite appropriate antibiotic therapy”	I	B
	“Aortic of mitral NVE or PVE with isolated large vegetations (> 15 mm) and no other indication for surgery”	IIb	C
	“Aortic or mitral NVE with vegetations > 10 mm, associated with severe valve stenosis or regurgitation, and low operative risk”	IIa	B
	“Aortic or mitral NVE or PVE with isolated very large vegetations (> 30 mm)”	IIa	B
2023
	“Urgent surgeryb is recommended in aortic or mitral NVE or PVE with persistent vegetations ≥ 10 mm after one or more embolic episode despite appropriate antibiotic therapy”	I	B
	“Urgent surgery is recommended in IE with vegetation ≥ 10 mm and other indications for surgery”	I	C
	“Urgent surgery may be considered in aortic or mitral IE with vegetation ≥ 10 mm and without severe valve dysfunction or without clinical evidence of embolism and low surgical risk”	IIb	B

ESC = European Society of Cardiology; NVE = Native valve endocarditis; PVE = Prosthetic valve endocarditis; IE = Infective endocarditis

^aAll 3 indications are recommended performed “within a few days” in the 2015 ESC guideline

^bWithin 3–5 days