What is the role of valve surgery in the management of infective endocarditis?
Valve surgery is an important option in the management of infective endocarditis (IE) as it can reduce the risk of embolic events. A systematic review of 15 population-based IE investigations from 7 countries showed that the proportion of IE cases undergoing valve surgery increased 7% between 1969 and 2000. In surveys involving population- and international multicenter cohorts, both nonvalvular and prosthetic valve endocarditis (NVE and PVE) patients underwent valve surgery during the active phase of IE (during initial hospitalization before completion of a full therapeutic course of antibiotics). A small randomized trial involving 76 patients with left-sided NVE, severe valve regurgitation without heart failure, and vegetations greater than 10 mm found that early surgery within 48 hours significantly reduced the composite outcome of in-hospital deaths and embolic events compared to conventional treatment. 