Key Points

1. Surgical consultation early in the course of the disease should be considered in all patients with IE, as about a third of IE patients require surgery during their hospitalization.

2. A thorough pre-operative workup from infectious and hemodynamic standpoints is crucial.

3. The main indications for surgery are hemo-dynamic instability, persistent sepsis, and recurrent embolization.

4. Hemodynamic stability must be prioritized over medical control of infection.

5. Native valve reconstruction (repair) is superior to replacement in terms of morbidity and tends to be associated with better survival.

6. PVE, intracardiac abscesses, poor LV function, and staphylococcal or culture-negative IE are associated with less favorable postoperative outcomes.

7. Outcome in the first postoperative year predicts the long-term course.

8. In properly selected surgical candidates, excellent results can be expected.

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