This chapter provides a comprehensive overview of the surgical management of infective endocarditis (IE), emphasising its prevalence, urgency, and the critical role of timely intervention in optimising patient outcomes. Despite its relatively low incidence, IE can rapidly lead to severe complications, including valvular destruction, systemic embolisation, and haemodynamic collapse, necessitating urgent or emergency surgery in many cases. The chapter highlights the importance of early surgical intervention—often within 48–72 h for high-risk patients—as data demonstrate significant reductions in mortality, recurrent embolic events, and chronic heart failure. Surgical timing is discussed in the context of heart failure, uncontrolled infection, and prevention of embolic events, guided by the latest ESC guidelines. Special attention is given to surgical timing post-stroke, considering the risks of haemorrhagic transformation. Multidisciplinary collaboration between cardiologists, surgeons, and infectious disease specialists is crucial in decision-making, particularly when balancing the risks of early surgery with the potential for improved long-term outcomes. This chapter also addresses the practical challenges of managing IE, offering guidance on handling complex cases involving haemodynamic instability, recurrent infection, and multi-organ dysfunction, thus providing a valuable resource for cardiac surgeons navigating the intricacies of IE surgery.