Table 2. Surgical indications: heart failure.

Guidelines	Recommendation	Level/class of evidence
ESC guidelines	Aortic or mitral NVE or PVE with severe acute regurgitation, obstruction or fistula causing refractory pulmonary edema or cardiogenic shock—timing of surgery: emergent	I/B
	Aortic or mitral NVE or PVE with severe regurgitation or obstruction causing symptoms of HF or echocardiographic signs of poor hemodynamic tolerance—timing of surgery: urgent	I/B
	Right HF secondary to severe tricuspid regurgitation with poor response to diuretic therapy	IIa/C
AHA/ACC guidelines	Early surgery (during initial hospitalization before completion of a full therapeutic course of antibiotics) is indicated in patients with IE who present with valve dysfunction resulting in symptoms of HF	I/B
	Early surgery (during initial hospitalization before 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

ESC guidelines show greater stratification in choosing the correct intervention timing. Both identify the onset of symptoms attributable to HF and the presence of cardiac structural damage as an indication for surgical treatment. IE, Infective endocarditis; ESC, European Society of Cardiology; AHA, American Heart Association; ACC, American College of Cardiology; HF, heart failure; NVE, native valve endocarditis; PVE, prosthetic valve endocarditis.