Which patients with endocarditis will benefit from early surgery is vigorously debated. Prospective randomized trials have demonstrated that patients with infections of native mitral and aortic valves associated with large vegetations and severe valvular regurgitation benefit from early surgery in terms of longer survival and fewer embolic complications1; several observational studies2,3 using propensity score analysis have also supported early surgery in high-risk patients.
Bolger AF. Challenges in Treating Prosthetic Valve Endocarditis. JAMA Intern Med. 2013;173(16):1504–1505. doi:10.1001/jamainternmed.2013.7020