The surgical management of bacterial valvular endocarditis.

Bacterial endocarditis is an important cause of cardiac valvular problems. The diagnosis of bacterial endocarditis can be difficult, and, often, an aggressive clinical evaluation including serial blood cultures is necessary. The pathophysiology of endocarditis is changing with the rise of intravenous drug use; staphylococci are an increasingly common cause. Endocarditis often warrants surgical intervention. Operations for bacterial endocarditis range from valve repair to valve replacement to homograft replacement. The operations are technically challenging, but new methods of myocardial protection have markedly improved the surgical outcomes. Valve excision is an option for intravenous drug users with tricuspid valve endocarditis. Surgical management of endocarditis is a technically challenging but rewarding procedure that should be offered to appropriate patients.