**Conflict of interest**

**2.** *Timing of surgery.*

124 Advanced Concepts in Endocarditis

with large, mobile vegetations (Class IIa).

**3.** *Neurologic complications and surgery for PVE.*

bleeding prior to operation (Class IIa).

valve prostheses used (Class IIa).

preferable to a prosthetic valved conduit (Class IIa).

cranial hemorrhage (Class IIa).

be beneficial (Class IIa).

**4.** *Technical considerations.*

**7. Conclusions**

• Once an indication for surgery is established, the patient should be operated on within days (Class I). Earlier surgery (emergency or within 48 hours) is reasonable for patients

• Patients should be on appropriate antibiotic therapy at the time of surgery (Class I). Once a patient is on an appropriate antibiotic regimen, further delay of surgery is unlikely to

• An operative delay of 3 weeks or more is reasonable among patients with recent intra-

• Patients with PVE and neurologic symptoms should undergo brain imaging (Class I); it is reasonable to screen patients with left-sided IE for possible stroke or intracranial

• Aortic PVE. If the root and the annulus are preserved after radical debridement in prosthetic aortic valve IE, implantation of a new prosthetic valve (tissue or mechanical) is reasonable (Class IIa). If there is annular destruction and invasion outside the aortic root, then the root reconstruction and use of an allograft or a biologic tissue root are

• Mitral PVE.When there are annular destruction and invasion, the annulus is reconstructed and the new prosthetic valve anchored to the ventricular muscle or to the reconstruction

• Among patients on dialysis, normal indications for surgery are reasonable, but additional comorbidities must be factored into assessments of risks and outcomes (Class IIa). Shorter durability of bioprostheses and allografts may be considered in the choice of

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

patch in a way to prevent leakage and pseudoaneurysm development (Class IIa).

None of the authors of this chapter have any disclosures or conflicts of interest to report in the context of the material presented.
