General Principles for Surgical Treatment of Infective Endocarditis

Even if we think of infective endocarditis as a heart valve infection, it is also a systemic disease with many possible systemic manifestations and complications. Patient management requires a multi-specialty team, of which the cardiac surgeon is an important member. All patients are treated with antimicrobials, but the cardiac surgeon is needed when valves are destroyed or leaky, when the infection is invasive and integrity of the heart is jeopardized, or when the infection involves a prosthetic valve. The surgeon removes infected prosthetic valves, other foreign material, and necrotic tissue, restores functioning valves and cardiac integrity, and eliminates the cardiac source of embolism. Operations for infective endocarditis are difficult operations on sick patients and have the highest mortality of any valve surgery. Surgery for infective endocarditis requires well-trained and experienced surgeons who understand the pathology, have mastered complex reconstructions, and are working in an environment providing necessary support.