Prosthetic Valve Endocarditis and the Operative Window: From Deferral to Deterioration.

TOPIC: Prosthetic valve endocarditis is a high-risk form of infective endocarditis in which redo surgery, infection control, hemodynamic instability, and timing of intervention often collide. DISCUSSION SUMMARY: Endocarditis Teams are recommended for complex infective endocarditis care, but in prosthetic valve endocarditis an important gap may persist after surgery is accepted in principle. Some deferral is appropriate when it is time-bound and aimed at stabilization, completion of imaging, neurologic clarification, or organ support. However, repeated deferral without a target can allow infection, periannular destruction, hemodynamic collapse, and multiorgan failure to progress until the operative window is lost. A third pathway is an explicit nonoperative or palliative decision when surgery is futile or inconsistent with the goals of care. TAKE-HOME MESSAGES: In prosthetic valve endocarditis, deferral should be classified, documented, and time-bound. The Endocarditis Team should protect the operative window, not merely recommend surgery.