Complicated Left-Sided Native Valve Endocarditis in Adults

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Abstract
In the preantibiotic era, native valve endocarditis was virtually always fatal. Since the advent of antibiotic therapy, mortality decreased to 24% to 60% in published case series, with heart failure representing the leading cause of death.1-4 During the past 3 decades, studies have suggested that valve surgery should be considered for patients with native valve endocarditis associated with complications that adversely affect prognosis: heart failure,5-10 new valvular regurgitation,11-13 refractory infection (ie, persistent fever or bacteremia, fungemia, or paravalvular abscess),14,15 systemic embolization to vital organs,16,17 and the presence of a vegetation on echocardiography as this represents a plausible risk for embolization.18-20 However, methodological limitations of existing studies, the absence of randomized controlled trials, and the lack of a validated method to classify prognostic severity make management decisions problematic.