Table 11. Class I Indications for Surgery in Left-Sided Valve Infective Endocarditis (Recommendations from the American Association for Thoracic Surgery (AATS) 2016 Consensus Guideline)[377].

Indications	Class of recommendation	Level of evidence
Surgery during initial hospitalization independently of the completion of a full therapeutic course of antibiotics is indicated in patients with IE who present with valve dysfunction resulting in symptoms of heart failure	I	B
Surgery during initial hospitalization independently of the completion of a full therapeutic course of antibiotics is indicated in patients with left-sided IE caused by S. aureus, fungal, or other highly resistant microorganisms	I	B
Surgery during initial hospitalization independently of completion of a full therapeutic course of antibiotics is indicated in patients with IE complicated by heart block, annular or aortic abscess, or destructive penetrating lesions	I	B
Surgery during initial hospitalization independently of the completion of a full therapeutic course of antibiotics for IE is indicated in patients with evidence of persistent infection as manifested by persistent bacteremia or fever lasting longer than 5 to 7 days after initiation of appropriate antimicrobial therapy	I	B
Once an indication for surgery is established, the patient should be operated on within days	I	B
IE: Infective endocarditis.