TY - JOUR T1 - Early surgery in infective endocarditis with large vegetations significantly reduced mortality compared with conventional treatment JF - Evidence Based Medicine JO - Evid Based Med SP - 145 LP - 146 DO - 10.1136/eb-2012-100982 VL - 18 IS - 4 AU - Marie-Christine Herregods AU - Paul Herijgers Y1 - 2013/08/01 UR - http://ebm.bmj.com/content/18/4/145.abstract N2 - Commentary on: Kang DH, Kim YJ, Kim SH, et al. Early surgery versus conventional treatment for infective endocarditis. N Engl J Med 2012;366 :2466–73.OpenUrl The treatment of infective endocarditis (IE) is still a challenge. Despite the availability of transoesophageal echocardiography which enables earlier diagnosis, and the use of appropriate antibiotics, the death rate remains high (20%). The reasons are that the population continues to become older with more comorbidities and more aggressive microorganisms like Staphylococcus aureus and Enterococcus faecalis are more frequently responsible for IE. These microorganisms induce more tissue destruction in a short time, leading to severe heart valve dysfunction early in the course of the disease. This evolution necessitates valve surgery, according to the 2006 ACC/AHA1 and 2009 ESC guidelines.2 However, the issue is the timing of surgery. Every delay in surgery compromises the final result. However, there may be … ER -