[Indication for surgical intervention and surgical approach to complicated infective endocarditis]

Infective endocarditis is a disease with various presentations and conditions, so that the medical team faces many dilemmas, mainly on indications and timing for surgical intervention. The results of surgery depend upon many factors: the general preoperative condition of the patient, antibiotic treatment, timing of surgery, perioperative management, surgical techniques, postoperative management and follow-up. Optimal diagnosis and management of patients with infective endocarditis requires clinical judgment based on extensive experience. In spite of the current best practices and guidelines for surgical interventions in infective endocarditis, we face patients that do not "fall directly" into the obvious guidelines. This editorial covers some of the topics that remain controversial: timing for surgical interventions, selection of prosthetic valve type, technical aspects regarding complex infective endocarditis, and ethical decisions.