Despite advances in diagnosis and medical management, the need for valve surgery remains high in patients with IE and more so in those with aggressive infecting organisms. The primary consideration for surgical intervention is the hemodynamic derangement resulting from IE. Recent studies have shown that surgery can be successfully performed to restore hemody-namic stability and to help eradicate refractory infection, even in the setting of active IE before the completion of antibiotic treatment.

Valve surgery in IE carries high risks of short-and long-term complications, but the surgical results have steadily improved. Valve repair is preferable to valve replacement, if it is technically feasible. Aortic homografts are ideal in patients with aortic root destruction who requires extensive reconstruction of the aortic root and surrounding structures.

Optimal management of patients with IE requires a multidisciplinary approach, with surgical input an integral part of the management. Cardiac surgery team should be consulted soon after the diagnosis of IE is made, so that the surgical team is fully aware of the clinical course. This will provide the opportunity to develop a more comprehensive strategy and to avoid delay if and when surgery is required.

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