Medical School, University of Thessaly, Department of Thoracic and Cardiovascular Surgery

Infectious endocarditis remains a dangerous onset with incidence unchanged over the years and a high risk of morbidity and mortality approaching 30% at 1 year. Prolonged appropriate antibiotic therapy remains the most important component in the treatment for native valve endocarditis once the causative organism has been identified. Rapid diagnosis, effective treatment, and prompt recognition of complications are essential to improve patient outcome. Nevertheless depending on the virulence of the microorganism, the extent of the infection evolving surrounding tissues and on whether the infected valve is native or prosthetic, surgery may become indispensable to eradicate the infection. Although according to international guidelines surgical treatment is necessary in 25-50% of cases during the acute phase of infection, and 20-40% during the recovery phase, it should be noted that these guiding instructions are not supported by robust clinical evidence and the clinical decision-making is often influenced by various factors, including advanced patient age and general comorbidities, the presence of extracardiac complications, as well as the availability of adequate surgical experience and expertise.  This is a brief review of the evidence base that supports current clinical practice aiming to clarify the role of surgery in areas where doubt still persists.