Infective endocarditis 2006: indications for surgery.

Infective endocarditis has challenged clinicians for centuries. Despite recent advances in diagnosis and therapy, the risks of major complications and death in many clinical situations remain unacceptably high, related in part to patient demographics and the changing microbiology of the disease. Surgery in the acute phase is indicated chiefly for the treatment of heart failure, the eradication of intra-cardiac abscess or the management of antibiotic-resistant infection. Surgery for the prevention of systemic embolization in patients with large vegetations is an evolving area of clinical practice that will merit continued scrutiny as surgical repair techniques, anesthetic management and perioperative patient outcomes steadily improve in high volume centers. The strength of treatment recommendations is limited by the absence of prospective, randomized controlled trial data, a limitation that applies broadly to the field of valvular heart disease. Ongoing multi-center registry efforts will help fill several important knowledge gaps.