Despite medical advances, the mortality in infective endocarditis is today very high. Its clinical and epidemiological characteristics are changing over time, with more elderly patients affected, with more underlying comorbidities and with Staphylococci as the most frequent pathogen. Effective treatment in complicated cases needs a multidisciplinary approach, and surgery is necessary in 40-50% of cases. Since clinical trials are difficult to be conducted in infective endocarditis, the scientific evidence is weak. The main indications of surgical treatment are heart failure due to valvular regurgitation and uncontrolled infection because of periannular extension or difficult-to-treat micro-organisms. Prospective analysis has demonstrated that medical-surgical treatment is better than only medical treatment in complicated endocarditis with severe cardiac failure but mortality is still high with periannular extension. Prosthetic endocarditis has better prognosis with surgical treatment in the presence of complications and when the aetiology is S aureus. In patients without extensive non-hemorrhagic neurological lesions, early surgical intervention is safe. Mitral repair is nowadays an effective surgical technique when there is not extensive valve destruction, since replacement with a prosthetic valve has several problems like risk of infection, requirement for anticoagulation and durability. There is no evidence that the employment of homografts is better than aortic valve replacement, and the most important issue is the complete removal of the infected tissue. The pacemaker and defibrillator infection is best treated by removal of the device and the leads along with effective antibiotic therapy. Percutaneous lead extraction is the method of choice, and surgery is reserved only when there are contraindications or failure of the percutaneous techniques, large vegetations, and tricuspid regurgitation. Whenever is possible, tricuspid repair, is preferable, but replacement must be considered when there is a chance for recurrence after repair.
Keywords: Infective endocarditis, surgical treatment, valvular disease
Current Pharmaceutical Design Pathogenesis of Chronic “Cor pulmonale” in COPD
Current Respiratory Medicine Reviews Serelaxin: New Investigational Treatment in Acute Heart Failure
Cardiovascular & Hematological Agents in Medicinal Chemistry L-Arginine Transport in Disease
Current Medicinal Chemistry - Cardiovascular & Hematological Agents Resistance to Diuretics in Heart Failure: Any Role for Empagliflozin?
Current Vascular Pharmacology Combinations of Renin-Angiotensin-Aldosterone System Antagonists:True Advantages?
Current Pharmaceutical Design The Role of Endothelin System in Cardiovascular Disease and the Potential Therapeutic Perspectives of its Inhibition
Current Topics in Medicinal Chemistry Advanced Nanomedicines for the Treatment and Diagnosis of Myocardial Infarction and Heart Failure
Current Drug Targets Olive Oil-related Anti-inflammatory Effects on Atherosclerosis: Potential Clinical Implications
Endocrine, Metabolic & Immune Disorders - Drug Targets Surgical or Interventional Revascularization in Diabetic Patients with Coronary Artery Disease?
Current Diabetes Reviews The Ryanodine Receptor: A Pivotal Ca2+ Regulatory Protein and Potential Therapeutic Drug Target
Current Drug Targets Sodium Ion Transporters as New Therapeutic Targets in Heart Failure
Cardiovascular & Hematological Agents in Medicinal Chemistry Sympathetic and Baroreflex Function in Hypertension: Implications for Current and New Drugs
Current Pharmaceutical Design Relaxin, Insulin and Diabetes: An Intriguing Connection
Current Diabetes Reviews Ryanodine Receptor - A Novel Therapeutic Target in Heart Disease
Recent Patents on Cardiovascular Drug Discovery (Discontinued) Preoperative Albumin Level Serves as a Predictor for Postoperative Pulmonary Complications Following Elective Laparoscopic Gastrectomy
Current Pharmaceutical Design Tyrosine Kinase Inhibitors – A Review on Pharmacology, Metabolism and Side Effects
Current Drug Metabolism Phase 4 Studies in Heart Failure - What is Done and What is Needed?
Current Cardiology Reviews Changes in the Expression of the Alzheimers Disease-Associated Presenilin Gene in Drosophila Heart Leads to Cardiac Dysfunction
Current Alzheimer Research The Therapeutic Potential of Hepatocyte Growth Factor for Myocardial Infarction and Heart Failure
Current Pharmaceutical Design