Abstract
<jats:p>Infective endocarditis remains one of the most complex conditions in cardiology and cardiovascular surgery, particularly in cases involving extensive valvular destruction, periannular abscesses, involvement of the aorto-mitral continuity, and the need for anatomical reconstruction in the setting of active infection. In this context, surgery is not limited to valve replacement but also involves radical debridement, local infection control, reconstruction of adjacent structures, and a careful choice between valve repair and replacement. The present study aimed to analyze, in light of the scientific literature, the main challenges of the surgical management of infective endocarditis, with an emphasis on valvular reconstruction. This is a narrative literature review, conducted through a search of scientific publications, clinical guidelines, and relevant clinical studies on endocarditis surgery, with particular emphasis on international reference documents and recent meta-analyses. The findings indicate that the main surgical indications remain related to heart failure, uncontrolled infection, and the prevention of embolic events, while the choice of technique depends on the extent of tissue destruction, the affected valve, the etiological agent, and the experience of the surgical team. Valve repair, when anatomically feasible, presents important advantages—especially in the mitral valve—whereas replacement remains indispensable in cases of extensive destruction. It is concluded that valvular reconstruction in infective endocarditis requires a high level of technical complexity, individualized decision-making, and integration among cardiac surgery, infectious diseases, echocardiography, and clinical cardiology, constituting one of the most challenging fields in contemporary cardiac surgery.</jats:p>