Role of Echocardiography in Guiding the Optimal Timing of Surgery in Infective Endocarditis

Infective endocarditis (IE) is a complex cardiovascular infection with the potential for multiorgan complications. While early surgery can be life saving in IE patients with acute heart failure and acute valve regurgitation, the appropriate timing of surgery for embolic complications is less certain. The ongoing debate concerns the ideal timing of surgical therapy and stems primarily from a scarcity of therapeutic randomized controlled trials in this population. Based largely on the evidence from observational studies and expert consensus, the European Society of Cardiology has issued guidelines on the optimal surgical timing in IE. Nonetheless, selection bias in published studies and the clinical complexity of this disease entity continue to pose management challenges in the individual patient. In this review, we focus on the cardinal role of echocardiography as a diagnostic tool in patients with complicated IE and discuss the available evidence pertaining to the ideal timing of surgical intervention.