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Emergency Surgery on DOAC — EECC MCQ

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HardArrhythmia & ElectrophysiologyEmergency Surgery on DOACEECC

A patient with tricuspid-valve endocarditis has a persistent 24-mm vegetation, recurrent septic pulmonary emboli and severe tricuspid regurgitation causing right-heart failure despite appropriate antibiotics. What should the endocarditis team do next?

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Correct answer: B — Arrange early surgical source-control assessment, considering repair before valve replacement

A persistent right-sided vegetation above 20 mm with recurrent pulmonary emboli and severe TR causing right-heart failure meets criteria for intervention; repair is preferred when feasible. Antibiotic-only delay does not provide source control. Percutaneous aspiration can be a selected bridge or alternative in prohibitive surgical risk but does not correct severe TR here. Anticoagulation does not sterilise vegetation or reliably prevent septic emboli, and culture clearance alone does not remove the haemodynamic and embolic indications.

Reference: 2023 ESC Guidelines for infective endocarditis. https://academic.oup.com/eurheartj/article/44/39/3948/7243107