Current treatment options for patients with endocarditis: The evolving indications for cardiac surgery

Abstract

Infective endocarditis (IE) is a serious and deadly disease. Despite medical advances over the past half century, more than one half of patients with IE suffer a serious complication, and the mortality rate remains approximately 20% during the initial hospitalization and approaches 40% at 1 year. In patients with documented IE, the treatment centers on two main aspects: effective antibiotic therapy and consideration of surgical therapy. Effective antibiotic therapy is the mainstay of treatment and focuses on sustained bactericidal concentrations tailored specifically to the causative microorganism. Surgical therapy is also an important option for many patients with IE. The goals of surgical therapy are to eradicate the focus of infection, to repair endocardial destruction, and to prevent the development of complications and relapse of infection. Ideally, surgical therapy should offer a survival advantage over medical therapy alone. Recent evidence supports the survival benefit of surgery in patients with IE, specifically in those with heart failure and complicated, left-sided IE. Future therapeutic strategies may include broader indications for surgery, as well as new treatments such as immune-modulating agents.