Heart failure unresponsive to medical therapy
Acute aortic or mitral insufficiency with signs of ventricular failure
Persistent vegetation after systemic embolization
Anterior mitral leaflet vegetation, particularly with size > 10mm
Severe valve regurgitation and mobile vegetations >10mm
One or more embolic events during first two weeks of antimicrobial therapy
Increase in vegetation size despite appropriate antimicrobial therapy
New heart block
Perivalvular extension, annular or aortic abscess, destructive penetrating lesions
Valvular dehiscence, rupture or fistula
Large abscess or extension of abscess despite appropriate antimicrobial therapy
Fungi or highly resistant organisms (VRE, multi-drug resistant Gram-negative bacilli)
Persistent bacteremia or fever lasting more than 5-7 days after starting appropriate antimicrobial therapy
Guidelines