Optimal timing for cardiac surgery in infective endocarditis: is earlier better?

Abstract

All patients with infective endocarditis should be transferred to a hospital with cardiac surgery facilities. Once the decision to operate on a patient with infective endocarditis has been made, the timing of surgery is very often a difficult decision. Literature on this topic is very scarce. The European Society of Cardiology guidelines include recommendations on the timing of surgery. Heart failure, uncontrolled infection and prevention of embolic risk are the three main indications for surgery. Most often, when the decision to operate has been made, there is no benefit and potentially harm in delaying surgery. If cardiac surgery is indicated after an ischemic stroke, it should not be delayed. Discussion should be multidisciplinary and involve at least a cardiologist, a cardiac surgeon and an infectious diseases specialist, and any other specialist as needed (for example a neurologist).