Early surgery (during initial hospitalization and before completion of a full course of antibiotics) is indicated in patients with IE who present with valve dysfunction resulting in symptoms or signs of heart failure (Class I; Level of Evidence B). 2. Early surgery should be considered particularly in patients with IE caused by fungi or highly resistant organisms (eg, vancomycin-resistant Enterococcus, multidrug-resistant Gram-negative bacilli) (Class I; Level of Evidence B). 3. Early surgery is indicated in patients with IE com- plicated by heart block, annular or aortic abscess, or destructive penetrating lesions (Class I; Level of Evidence B). 4. Early surgery is indicated for evidence of persistent infection (manifested by persistent bacteremia or fever lasting >5 7 days and provided that other sites of infection and fever have been excluded) after the start of appropriate antimicrobial therapy (Class I; Level of Evidence B). 5. Early surgery is reasonable in patients who present with recurrent emboli and persistent or enlarging vegetations despite appropriate antibiotic therapy (Class IIa; Level of Evidence B). 6. Early surgery is reasonable in patients with severe valve regurgitation and mobile vegetations >10 mm (Class IIa, Level of Evidence B). 7. Early surgery may be considered in patients with mobile vegetations >10 mm, particularly when involving the anterior leaflet of the mitral valve and associated with other relative indications for sur- gery (Class IIb; Level of Evidence C). Early Valve Surgery in PVE: Recommendations 1. Early surgery is indicated in patients with symp- toms or signs of heart failure resulting from valve dehiscence, intracardiac fistula, or severe prosthetic valve dysfunction (Class I; Level of Evidence B). 2. 