Reassessment of Vegetation Size as a Sole Indication for Surgery in Left-Sided Infective Endocarditis

Etiology, Risk Factors and Clinical Outcomes in Infective Endocarditis Patients Requiring Cardiac Surgery

“…Despite the lack of difference in the intrahospital mortality when IE caused by different bacterial agents is compared, the study suggests the worse long-term clinical outcomes for endocarditis in the cases of S. aureus. This statement is in agreement with the results obtained by other authors suggesting the presence of S. aureus is associated with poor outcomes and high mortality in IE [ 26 ]. Opposingly, as demonstrated in this study, E. faecalis caused IE presents a less severe course, complications, and better outcomes in surgically treated patients.…”

Measurement of vegetations in infective endocarditis: An inaccurate method to decide the therapeutical approach

“…In LSIE patients, the benefit of surgery is well established when heart failure or uncontrolled infection are present. In the absence of these complications, surgery indication is a matter of debate [ 8 , 9 ], but is recommended if the vegetation is larger than 15 mm or 10 mm by the current European and American guidelines, respectively [ 1 , 2 ]. The current study shows that the interobserver variability of the length of a vegetation is high enough to affect the surgical indication in an unacceptable proportion of patients and should be taken with caution in establishing a surgical indication.…”

Left-Sided Infective Endocarditis: Time to Personalize Care Management

“…Specifically, they found that vegetation size (>10 mm) alone was not a predictor of death, unlike age, presence of Staphylococcus aureus, perivalvular complications, heart failure, kidney failure, and septic shock, which were associated with death. 1 We have anecdotally observed surgery being recommended to frail elderly patients with large vegetations (but with no other indication of treatment failure and who were otherwise improving with medical therapy) and certainly hope the current study would temper enthusiasm for surgery based on size alone.A concern in the analysis of surgery in 139 patients of group A without heart failure and uncontrolled infection is that perivalvular complications such as abscess or fistula were not excluded. These would traditionally be considered indications for surgery as well.…”

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We read with great enthusiasm the findings reported by Cabez on et al 1 that vegetation size should not be the sole criterion when considering surgery in cases of left-sided infective endocarditis (LSIE). 1 Over the years, several publications involving multidisciplinary teams have addressed which clinical variables are important, but the decision for early surgical intervention versus continued antibiotic treatment in LSIE remains controversial. [2][3][4][5] The results from Cabez on et al remind us that LSIE treatment remains controversial and there is no ''one-size-fits-all'' recommendation.

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