Cardiac surgical intervention has an increasingly important role in the treatment of intracardiac complications of endocarditis. Retrospective data suggest that mortality is unacceptably high when these complications are treated with antibiotics alone, whereas mortality is reduced when treatment combines antibiotics and surgical intervention.

It encompasses both radical valve replacement and more conservative vegetectomy and valve repairs. Surgery is necessary in 25-30 per cent of cases during acute infection, and in 20-40 per cent in later phases. The final outcome has little relation to the duration of previous antibiotic therapy. Results of studies on surgery for active infective endocarditis indicate mortality rates of 8-16 per cent, with actuarial survival at 5 years of 75-76 per cent and at 10 years of 61 per cent.