Aortic valve endocarditis: is there an optimal surgical timing?

Abstract

Patients with aortic valve infective endocarditis are likely to undergo surgery during the active phase of the disease. The indication and best timing for surgery, however, are still debated. The present review discusses the benefits and risks of early surgery in aortic endocarditis. Patients with acute aortic regurgitation and clinical or echocardiographic signs of poor tolerance require urgent surgery. Other indications for early surgery include severe perivalvular involvement and high embolic risk. Echocardiography plays an important role in the assessment of embolic risk and helps in choosing the best therapeutic strategy. Several recent studies have identified high-risk subgroups of patients that, without surgery, face poor prognosis. Patients with complicated endocarditis, particularly those with congestive heart failure, will benefit most from surgery. Patients with prosthetic valve endocarditis and cerebral complications represent specific subgroups in which surgical decision is more difficult. Patients with severe aortic leaflet destruction and congestive heart failure, patients with perivalvular extension or uncontrolled infection, and patients with high embolic risk have poor outcome under medical therapy. Early surgery is necessary in all such patients with 'complicated' endocarditis, unless severe comorbidity is present.