Delahaye et al identified the best time to operate on a patient with infective endocarditis based on the extent of disease and complications. The authors are from Hopital Cardiovasculaire et Pneumologique in Lyon.
Patient selection: infective endocarditis
Emergency cardiac surgery should be performed for
(1) acute aortic regurgitation AND early closure of the mitral valve
(2) rupture of a sinus of Valsalva aneurysm into a right heart chamber
(3) rupture into the pericardium
Urgent cardiac surgery (within 2 days):
(1) obstruction of a valve
(2) instability of a valve prosthesis
(3) NYHA class III or IV heart failure AND acute aortic or mitral valve regurgitation
(4) septal perforation/rupture
(5) new onset of a conduction disturbance
(6) mobile vegetation > 10 mm in diameter AND major embolism AND appropriate antibiotic therapy less than 7-10 days
(7) mobile vegetation > 15 mm in diameter AND appropriate antibiotic therapy less than 7 to 10 days (evidence inconclusive)
(8) no effective antimicrobial therapy available
(9) annular or aortic abscess
(10) sinus or aortic true or false aneurysm
(11) fistula formation
Non-urgent (sooner the better):
(1) infection of prosthetic valve with Staphylococcus
(2) prosthetic valve infection less than 2 months after surgery
(3) progressive paravalvular prosthetic leak
(4) valve dysfunction AND persistent infection AND appropriate antibiotic therapy more than 7 to 10 days AND no non-cardiac cause of infection
(5) fungal endocarditis (yeast or mold)
(6) infection with an organism that is difficult to treat
(7) vegetation growing in size despite appropriate antibiotic therapy for more than 7 days (evidence inconclusive)