**2. Historical note**

In 1885, Osler observed an association between perioperative bacteremia and endocarditis [7]. In 1935, Okell and Elliott noted that 11% of patients with poor oral hygiene had positive blood cultures for *Streptococcus viridans*, and that 60% of patients had bacteremia associated with dental extraction [8]. Not long after, initial reports of valve replacements by Starr and Harken, the first reports of PVE appeared in the literature [9, 10]. Before the routine use of prophylactic antibiotics, Geraci and Stein reported incidences of early PVE of 10 and 12%, respectively [11, 12]. The use of routine prophylactic antibiotics was noted to reduce the incidence of early PVE to 0.2% [11]. From the outset, the surgical management of PVE has been a formidable challenge. In the 1960s and 1970s, surgery for PVE was associated with an extremely high mortality rate. Discouraged by early operative experience, cardiac surgeons avoided intervention in cases of PVE despite recognition that antibiotic therapy alone was ineffective and often fatal. Surgery for PVE was reserved for high risk cases, and the surgical outcomes were predictably poor. Hence, a vicious cycle developed in which surgery was avoided for fear of poor surgical outcomes, and poor surgical outcomes achieved in high risk cases reinforced this fear.

In 1972, Ross successfully performed an aortic root replacement for PVE using an aortic homograft [13]. His report stressed surgical principles still true today: complete surgical debridement of all infected tissue, the use of homograft for reconstruction, and the minimal use of foreign material in the infected area [13]. In 1977, Olinger and Maloney reported replacement of an infected aortic prosthesis and external felt buttressing for correction of aortoventricular discontinuity [14]. In 1980, Frantz reported successful repair of an aortoventricular discontinuity from endocarditis and abscess formation by aortic root replacement using a synthetic valved conduit [15]. In 1981, Reitz successfully applied this technique to the treatment of prosthetic aortic valve endocarditis [16]. In 1982, Symbas combined aortic valve replacement with patch repair of a periannular abscess cavity [17]. In 1987, David and Feindel described techniques to reconstruct the mitral annulus with pericardium after debridement for PVE [18].

Surgical treatment of PVE remains a significant challenge, but outcomes improved in the 1990s. Factors that contributed to improved outcomes included:

