Cardiac surgery for infective endocarditis requires early team referral, timely optimisation and decisive perioperative troubleshooting. Key issues include molecular testing of operative valve tissue, antithrombin-related heparin resistance, vasoplegia and low cardiac output after bypass.

Modern infective endocarditis often presents as acute healthcare-associated sepsis without classical peripheral signs. Diagnosis depends on several adequately filled pre-antibiotic blood-culture sets, valve- and device-appropriate imaging, and careful distinction of vegetations from common mimics.