What are the indications for early surgery in patients with right-sided endocarditis?
Early surgery is indicated in patients with right-sided endocarditis when the infection is complicated by heart block, annular or aortic abscess, or destructive penetrating lesions (Class I; Level of Evidence B). Early surgery is reasonable for patients with persistent bacteremia despite appropriate antibiotic therapy for 5-7 days in whom other sites of infection have been excluded (Class I; Level of Evidence B). Additionally, early surgery is indicated for patients with endocarditis caused by fungi or highly resistant organisms (Class I; Level of Evidence B). For patients with recurrent emboli despite appropriate antibiotic treatment, early surgery is reasonable (Class IIa; Level of Evidence B). For patients with relapsing endocarditis, early surgery is reasonable (Class IIa; Level of Evidence C). Finally, early surgery may be considered in patients with mobile vegetations greater than 10 mm (Class IIb; Level of Evidence C).