Surgical Treatment Options for Infectious Endocarditis

Infectious endocarditis is a serious condition that affects the inner lining of the heart and can damage heart valves. While some patients respond well to medical treatment, others may require surgical intervention. The decision to proceed with surgery depends on several key factors, which are outlined below.

When Surgery is Necessary

1. Size and Risk of Embolization of VegetationsInfectious endocarditis often leads to the formation of vegetations—clumps of bacteria and cells—on the heart valves. If these vegetations grow larger than 1 cm, they pose a significant risk of breaking off and causing embolisms, which can lead to strokes or organ damage. Although antibiotics are the first line of treatment, they may not effectively eliminate large vegetations. In such cases, surgical removal is often recommended to prevent life-threatening complications.

2. Valve Damage and Heart FailureProlonged bacterial infection can severely damage heart valves, leading to conditions like valve perforation or regurgitation. These complications can cause heart failure, which may become unmanageable despite aggressive medical therapy. When heart failure symptoms persist or worsen, early surgical intervention such as valve repair or replacement becomes crucial to restore proper heart function and improve long-term outcomes.

Uncontrolled Infection and Persistent Sepsis

3. Persistent Infection Despite Antibiotic TherapyBecause the heart continuously pumps blood to all parts of the body, an untreated infection within the cardiac chambers can spread systemically, leading to sepsis. If the infection remains active despite appropriate antibiotic treatment, surgical debridement of the infected tissue may be necessary. This helps eliminate the source of infection and prevents further complications like abscess formation or multi-organ failure.

In conclusion, while not every case of infectious endocarditis requires surgery, timely surgical intervention can be life-saving in patients with large vegetations, severe valve damage, or uncontrolled infections. A multidisciplinary approach involving cardiologists and cardiac surgeons is essential to determine the best treatment strategy for each individual patient.