In patients with an indication for surgery and a stroke but no evidence of intracranial hemorrhage or extensive neurological damage, surgery without delay may be considered. DUA indicates drug use as- sociated endocarditis; HF, heart failure; ICD, implantable cardioverter-defibrillator; ID, infectious disease; IE, infective endocarditis; IV, intravenous; NVE, native valve endocarditis; OST, opioid substitution treatment; pt, patient; PVE, prosthetic valve endocarditis; Rx, therapy; S. aureus, Staphylococcus aureus; TEE, transesopha- geal echocardiography; TTE, transthoracic echocardiography; VHD, valvular heart disease; and VKA, vitamin K antagonist. CLINICAL STATEMENTS AND GUIDELINES endocarditis, which is an important distinction in injectable drug users. Certain pathogens, such as Pseudomonas aeruginosa, Brucella, fungi, enterococci, and gram-positive cocci are extremely difficult to cure with medical therapy alone and are also prone to abscess or fistula for- mation and other cardiac tissue destruction. The mortality rate is also significantly lower in patients treated with antifungal agents combined with surgery than in those treated with antifungal agents alone (42% versus 59%).9,15,20,22,28 35 4. Abscess in native valve endocarditis is a life- threatening complication that cannot be cured with antibiotic therapy alone. Extensive para- valvular infections (including annular or aortic abscesses and destructive penetrating lesions or fistulae) are associated with a mortality rate of 40% and heart block. The long-term results of surgery are very satisfactory, with an actuarial survival rate of 75% 6% at 5 years. Freedom from recurrent IE has been reported to be 76% at 8 years. Surgical series have shown that the surgical results are related more to a surgeon s ability to remove all infected tissues and recon- struct functional anatomy than to the type of valve used for a replacement. 