Surgical Management of Infective Endocarditis: Indications, Techniques, and Outcomes.

Infective endocarditis (IE) remains a complex condition with high morbidity and mortality despite advances in antimicrobial therapy and diagnostic imaging. Surgery is required in up to half of patients, most commonly for heart failure, uncontrolled infection, or prevention of embolic events. Surgical timing, ranging from emergency to elective, is influenced by hemodynamic compromise, neurological status, pathogen virulence, and vegetation characteristics. Modern imaging modalities, including transesophageal echocardiography, cardiac CT, and 18F fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT), play a central role in surgical decision-making by detecting complications and guiding operative strategies. Intraoperative management focuses on radical debridement and restoration of valve function, with repair, replacement, or complex reconstructions tailored to the extent of infection and patient-specific factors. Prosthesis selection remains individualized, as no single valve substitute demonstrates clear superiority in survival, reinfection, or reoperation rates. Postoperative management requires prolonged antimicrobial therapy, vigilant follow-up, and rehabilitation, while recurrence risk highlights the importance of multidisciplinary care. Long-term prognosis depends on underlying comorbidities, pathogen type, and patient adherence to preventive measures. Future research should address gaps in surgical timing after neurological events, management of prosthetic and transcatheter-associated IE, and strategies for improving outcomes in high-risk populations.