**7. Conclusions**

Without a doubt, the incidence of native valve endocarditis is growing-the reasons for this are multifactorial and, in general, reflect a greater access to advanced cardiac surgical therapies. Sicker patients, older patients, and more patients are undergoing valve replacement surgery for an ever-expanding list of indications. Increased used of vascular access, be it for chronic electrical system therapies (i.e., pacemakers and defibrillators), medical therapies (i.e., chemotherapy, dialysis), or as an extension of intravenous substance abuse, all have contributed to a growing incidence of both native and prosthetic valve infections. Regardless, any prosthetic valve replacement leads to a life-time risk that these patients for the development of prosthetic valve infections-either as a result of their initial operation, their ongoing (and potentially worsening) comorbidities, or simply as a function of patients living longer and with a cumulative annual risk. The development of prosthetic valve endocarditis is often, and appropriately so, viewed as a catastrophic event due to its association with devastating complications (i.e., strokes), substantial risk for operative morbidity and/or mortality, and baseline comorbidities and functional status at the time of presentation. More than most other medical and surgical therapies, a timely engagement by a multidisciplinary team is crucial to the establishment of a short- and long-term treatment plan. Clearly, much like native valve endocarditis, patients with prosthetic valve infections have shown benefit from early and aggressive surgical therapies-once established indications for surgery have been met or it has been demonstrated that optimized medical therapies have failed. Such therapies, despite substantial perioperative risks, must be focused on with aggressive debridement and elimination of all prosthetic and infected material. While prolonged courses of antibiotics and nonoperative management may have a role in select patients with limited disease burden, or for those in whom surgical reintervention is deemed to be a prohibitive, it must be recognized that the risk of treatment failure in such patients often results in worse complications or premature death. In conclusion, the medical and specific surgical decisions when dealing with a prosthetic valve infection must be individualized to provide the patient with the best opportunity for a cure.
