Surgery in active endocarditis.

The role of surgery before the completion of a standard course of antibiotics in endocarditis continues to evolve. The most commonly cited indications for surgery include heart failure, repeated emboli, resistant infection, large vegetations seen by echocardiography, and deep tissue involvement. It has also been suggested that any prosthetic valve infected with a nonstreptococcal pathogen should be considered for early replacement. We discuss the rationale behind surgical intervention, critically review the pertinent literature, and propose guidelines for the clinical management of these patients.