title: Indications of Surgery in Infective Endocarditis.
abstract: OBJECTIVE
  Infective endocarditis (IE) is a serious disease with significant morbidity and mortality. Valve surgery is fundamental in the standard of care of selected IE patients. Indeed, valve surgery can be a lifesaving procedure in critically ill endocarditis patients. Our goal from this review is to discuss the indications of surgery in IE population and international cardiac societies' guideline recommendations.
  
  
  RESULTS
  Though IE is an uncommon disease, its incidence is noted to be on rise in some parts of the world, and the disease is expected to continue to be a major health problem. Antimicrobials remain the mainstay of IE therapy, but as many as 50% of endocarditis patients will undergo surgical intervention. Heart failure most commonly from acute valvular insufficiency, uncontrolled and persistent infection, and recurrent embolic events are the major indications for valve surgery in IE population. Heart failure is by far the most common indication for surgery in IE patients. Despite the fact that many IE patients will require surgical interventions, most of the international societies' recommendations to perform valve surgery are based on observational studies or experts' opinion. Surgery plays a major role in the management of IE patients, and it is most commonly performed in patients with heart failure, persistent or uncontrolled infection, and recurrent emboli. Most of the current evidence supporting surgical intervention in IE patients is based on observational studies and experts' opinion. Randomized clinical trials are urgently needed to guide surgical therapy in IE.
authors.affiliation: Department of Medicine, Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Int. Med. E315 GH, Iowa City, IA, 52242, USA.|College of Public Health, University of Iowa, Iowa City, IA, USA.
authors.forename: Aref A
authors.initials: AA
authors.lastname: Bin Abdulhak
authors.affiliation: Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA. itlaygeh@gmail.com.|Division of Epidemiology, Mayo Clinic, Rochester, MN, USA. itlaygeh@gmail.com.|Department of Medicine, Infectious Diseases Section, King Fahad Medical City, PO Box 59046, Riyadh, 11525, Saudi Arabia. itlaygeh@gmail.com.|College of Medicine, Al Faisal University, Riyadh, Saudi Arabia. itlaygeh@gmail.com.
authors.forename: Imad M
authors.initials: IM
authors.lastname: Tleyjeh
keywords: Acute valvular insufficiency; Heart failure; Heart surgery; Infective endocarditis (IE)