Can Infective Endocarditis Be Treated With Surgery?

Infective endocarditis is a serious infection that affects the inner lining of the heart and often involves the heart valves. While some patients can be treated effectively with medication alone, others may require surgical intervention. Surgery is not always necessary, and the decision depends on several key factors related to the patient's condition and response to initial treatment.

When Is Surgery Necessary?

1. Size and Risk of Embolization of Vegetations
One of the main reasons for surgical treatment is the presence of large vegetations — abnormal growths caused by infection on the heart valves. If a vegetation is larger than 1 cm, it poses a significant risk of breaking loose and causing an embolism, which can lead to stroke or organ damage. In such cases, even if antibiotics are being used, surgery may be recommended to remove the vegetation and prevent life-threatening complications.

2. Valve Damage and Heart Failure
Infective endocarditis can cause severe damage to heart valves due to bacterial destruction. This damage may result in valve perforation or regurgitation, which can lead to heart failure. If heart failure becomes severe and cannot be managed with medications, surgical repair or replacement of the affected valve becomes essential to restore normal heart function and improve the patient's prognosis.

3. Persistent Infection Despite Antibiotic Therapy
In some cases, the infection remains active despite appropriate antibiotic treatment. This can happen when bacteria form resistant colonies or when the infection is located in a difficult-to-treat area within the heart. Persistent infection increases the risk of systemic complications and may require surgical removal of infected tissue to achieve a full recovery.

Conclusion

The treatment of infective endocarditis requires a personalized approach. While antibiotics are the first line of defense, surgery plays a crucial role in managing complications such as large vegetations, valve dysfunction, and uncontrolled infections. Early evaluation by a cardiac specialist can help determine the most effective treatment strategy and improve long-term outcomes for patients.