Indications and optimal timing for surgery in infective endocarditis.

M ore and more patients are operated on during the active phase of infective endocarditis (IE). Between 1991 and 1999, in France, the rate of cardiac surgery has increased from 31% to 50%. This may, at least in part, explain the concomitant decrease of in hospital mortality, from 22% to 17%. Nonetheless, the indications for cardiac surgery and its optimal timing remain difficult decisions. The principal indications for cardiac surgery are heart failure, no control of infection, embolisms, large size of vegetations, severe valvar and perivalvar lesions, and infection caused by some microorganisms.