Indications for surgery-bacterial endocarditis

(consult early; JTCS 2017;153:1241; Circ 2021;143:e72)

• Emergent if refractory cardiogenic shock
• Urgent (during initial hospitalization): Sx HF Penetrating infection: periannular abscess, heart block, fistula, worsening conduction Persistent infection: ⊕ BCx after >5 d of appropriate abx, ↑ or ? large vegetation Emboli: recurrent or w/ residual large (>10 mm) vegetation & severe AR/MR. Cerebral emboli not contraindic. unless severe stroke or hemorrhage (Stroke 2006;37:2094). S. aureus, fungal or multiRx-resistant organisms PVE (emergent if dysfunction or dehiscence)