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Table 52.8

Indications for Transfer to a Surgical Centre

  • Prosthetic valve or implantable cardiac electronic device infection
  • Severe regurgitation even if currently stable haemodynamically
  • Intracardiac abscess
  • Invasive organism (e.g. S. aureus*)
  • Organisms that are hard to manage medically (e.g. fungi)
  • Failure to respond to antibiotics
  • Stroke (or other embolism) and large residual vegetation
  • Recurrent emboli
  • Renal failure†

* Some cases of S. aureus IE may respond to antibiotic therapy, but IE caused by this organism should trigger discussion with a surgical centre.

† Renal failure in IE has many and sometimes multiple origins including glomerulonephritis, renal emboli, aminoglycoside therapy and low cardiac output. It can contribute to the decision for early surgery when associated with severe valve destruction or failure to control sepsis and should therefore trigger a discussion with a surgical centre.