The risk of embo- lism is highest during the first days after initia- tion of antibiotic treatment and decreases after 2 weeks. Embolic incidence decreases to 9% to 21% after initiation of antibiotic treatment. Factors associated with a new embolic event are vegetation size >10 mm and marked vegetation mobility (especially when associated with the anterior leaflet of the mitral valve). Early sur- gery is associated with a reduction in the rate of embolic complications in patients who present with left-sided IE, severe VHD, and large vegeta- With native valve endocarditis, large vegetation size is associated with a markedly higher rate of embolic phenomena. In an RCT of surgical intervention in patients with severe left-sided valve dysfunction and vegetations >10 mm in CLINICAL STATEMENTS AND GUIDELINES length (even in the absence of clinically appar- ent embolic events or HF), there was no signifi- cant difference in all-cause mortality rate at 6 months in the early surgery versus the conven- tional treatment groups (3% and 5%, respec- tively; P=0.59); however, there was a marked reduction in the number of embolic events: 0% in the early surgery group compared with 21% in the conventional treatment group (P=0.005). Additionally, 77% of the conventional treat- ment group required surgery during the initial hospitalization or during the follow-up phase secondary to HF, paravalvular extension, and Stroke is an independent risk factor for postoperative death in patients with IE. Recommendations about the timing of opera- tive intervention after a stroke in the setting of IE are hindered by the lack of RCTs and reliance on single-center experiences. In early observa- tional data, there was a significantly decreased risk of in-hospital death when surgery was per- formed >4 weeks after the stroke.73 These data were not risk adjusted. 