Surgery

Surgical intervention has become an integral therapy in combination with pharmacologic management of IE. Valve replacement is the predominant intervention, and it is used in a minimum of 25% for all cases of IE.1 Surgery may be indicated if the patient has unresolved infection, ineffective antimicrobial therapy (often associated with fungal IE), more than one episode of serious emboli, refractory congestive heart failure, significant valvular dysfunction, a mycotic aneurysm requiring resection, local complications (perivalvular or myocardial abscesses), or a prosthetic-valve infection associated with a pathogen that demonstrates higher antimicrobial resistance (e.g., staphylococci, gram-negative organisms, and fungi).40,48,49 Often a patient's hemodynamic status (i.e., blood pressure, heart rate, pulmonary artery pressure, etc.) is used to determine when surgical intervention is warranted.50 Despite appropriate medical management and cure, a significant number of people who develop native-valve endocarditis require valve replacement surgery. Involvement of the aorta is considered an indication for surgery in over 70% of patients with PVE.50

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