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In addition to antibiotic therapy, early surgical intervention is often required for an effective treatment of infective endocarditis to manage the sequelae of destruction of the valve itself and the paravalvular structures but the decision about whether and when surgery is necessary is complex. According to the most recent ESC guidelines on the management of infective endocarditis, surgical treatment using valve repair or replacement is not recommended within the first month in patients who suffered from an intracranial hemorrhage (1). The exact wording of the guidelines is the following: Valve surgery may be considered in IE patients with stroke or subclinical cerebral emboli and residual vegetation without delay if intracranial hemorrhage has been excluded by imaging studies and neurological damage is not severe (ie, coma) (Class IIb; Level of Evidence B). In patients with major ischemic stroke or intracranial hemorrhage, it is reasonable to delay valve surgery for at least 4 weeks (Class IIa; Level of Evidence B).

european journal of cardio-thoracic surgery

Early valve repair or replacement is not generally contraindicated in patients with infective endocarditis and stroke with or without intracranial haemorrhage