Emergency Management of Infective Endocarditis

Cardiac surgery is required in more than 50% of patients with active infective endocarditis. Patients should be referred to an expert center for rapid evaluation. Surgical indication and timing have to be defined by an endocarditis team. Early surgery is beneficial not only in the absence of cerebral complications but also in patients with cerebral infarction without coma. Management of patients with intracranial hemorrhage remains very complex, but surgery may be performed within the first month after hemorrhagic stroke in selected patients if there is a strong indication for early surgery. The aim of surgery is (a) to eradicate the infection removing all the infected structures and materials, (b) to allow a bacteriological diagnosis, and (c) to perform an anatomical reconstruction of affected structures.