Table 2.

Comparison of Neurologically Relevant Recommendations for Surgical Intervention by American College of Cardiology (2006) and European Society of Cardiology Recommendations (2009).^a

	ACC	ESC
IE with persistent emboli despite appropriate antibiotic therapy	Surgery is indicated (class IIa)	Urgent surgery is indicated (class I)
IE with large left-sided vegetations	Surgery may be considered in NVE with mobile vegetations > 10 mm (class IIb)	Class I indication for urgent surgery with vegetations > 10 mm plus other predictors of complicate course such as HF, persistent infection, abscess (class I). Urgent surgery should be considered for isolated vegetations > 15 mm (class IIb)
After silent cerebral embolism or TIA	No recommendation	Surgery should proceed without delay if an indication remains (class I)
After intracranial hemorrhage	No recommendation	Surgery must be postponed for at least 1 month (class I)
After clinically relevant stroke	No recommendation	Surgery for HF, uncontrolled infection, abscess, or persistent high embolic risk should not be delayed. Surgery should be considered in absence of coma and CT evidence of hemorrhage (class IIa)

Abbreviations: IE, infective endocarditis; ACC, American College of Cardiology; ESC, European Society of Cardiology Recommendations; NVE, native valve endocarditis; HF, heart failure; TIA, transient ischemia attack; CT, computed tomography.

^a Per ESC guidelines, “urgent” surgery should be performed “within a few days”. Class I: evidence and/or general agreement that a given treatment or procedure is beneficial, useful, and effective. Class II: conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of the given treatment or procedure. Class IIa: weight of evidence/opinion is in favor of usefulness/efficacy. Class IIb: usefulness/efficacy is less well established by evidence/opinion. Class III: evidence or general agreement that the given treatment or procedure is not useful/effective and in some cases may be harmful.