Table 6.
Timing of surgery in infective endocarditis
|
Emergency Surgery (within 24 h) - IE with refractory pulmonary edema or cardiogenic shock determined by • Acute severe valvular regurgitation (aortic or mitral) or severe prosthetic dysfunction (dehiscence or obstruction) • Fistula into a cardiac chamber or the pericardial space |
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Urgent Surgery (within days) - IE with persistent heart failure, signs of hemodynamic instability on echocardiography determined by acute severe valvular (aortic or mitral) regurgitation or obstruction - Uncontrolled infection (large vegetation, abscess, pseudoaneurism, fistulae) - Fever and positive blood cultures persistence >7–10 days - Large mitral or aortic vegetation (>10 mm) with an embolic event despite suitable antimicrobial treatment or other predictors of a complicated course(heart failure, persistent infection, abscess) - Very large vegetation (>15 mm) |
|
Early Elective Surgery (during the in-hospital stay)
- Severe aortic or mitral regurgitation with no heart failure - Fungal or multiresistant infection infections resistant to medical therapy |