Infective Bacterial Endocarditis: When we ought to consult our surgical colleagues (CVT)

Infective Bacterial Endocarditis (IBE)- Indications for CVT Surgical Management

Beyond antibiotic therapy and supportive management, there are instances where patients with IBE should have an urgent referral to our CVT surgical colleagues for assessment for the utility of surgical intervention. 

The American College of Cardiology/American Heart Association developed guidelines (2006) on the management of valvular heart disease, including the role for surgical management in patients with native valve endocarditis. Surgical consultation should be sought early if there are possible indications that require expert opinion.

Current indications for surgical management in patients with native valve endocarditis include:

• Valvular dysfunction leading to severe heart failure
• Infection with organisms that are difficult to treat
• Valvular destruction leading to severe regurgitation, and altered hemodynamics (i.e. elevated LV end-diastolic and/or LAP)
• Persistent infection (i.e. peri-valvular abscess)
• Embolic events while on appropriate antibiotics OR embolic events associated with a large vegetation

NOTE: a vegetation >10 mm (or 1 cm) is not sufficient to require surgery, if there are no other indications 

Interesting Read/Resource:

Circulation (2010): Impact of Early Surgery on Embolic Events in Patients with Infective Endocarditis