[Early Surgery for Active Infective Endocarditis].

Indication of emergent or urgent surgery for patients with active infective endocarditis is considered taking into acount the control of heart failure, infection, and systemic embolism. In cases with cerebral complication, however, the timing of surgery should be decided considering the extent of cerebral damage and the risk of exacerbation. Asymptomatic and small stroke may not preclude the early surgical intervention, although more severe cerebral complication, such as intracranial hemorrhage, should require delay of surgery at least for 4 weeks. Prevention of reinfection by total removal of infected tissues and reconstruction of defected tissues is the principle of surgery. We prefer the tissue reconstruction using bovine pericardium and prosthetic valve. However, extensive tissue destruction by microorganisms could make it difficult to achieve complete resection. In such cases, we use local administration of antibiotics layered with fibrin glue aiming at sustained release of antibiotics.