Table 2.

Indications for surgery in left-sided valve endocarditis (74).

Heart failure

•Severe acute regurgitation, obstruction or fistula causing refractory pulmonary edema or cardiogenic shock.

Uncontrolled infection

• Locally uncontrolled infection (abscess, false aneurysm, fistula, or enlarging vegetation). • Persistent positive blood cultures despite appropriate antibiotic therapy. • Infection caused by fungi or multidrug-resistant organisms or prosthetic valve endocarditis caused by staphylococci or non-HACEK Gram-negative bacteria.

Prevention of embolism

• Persistent vegetations >10 mm after one or more embolic episode despite appropriate antibiotic therapy or severe valve stenosis or regurgitation. • Isolated very large vegetations (>30 mm).