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. Early surgery should be done in patients who have persistent bacteremia despite appropriate antibi- otic therapy for 5 to 7 days in whom other sites of infection have been excluded (Class I; Level of Evidence B). 3. Early surgery is indicated when IE is compli- cated by heart block, annular or aortic abscess, or destructive penetrating lesions (Class I; Level of Evidence B). 4. Early surgery is indicated in patients with PVE caused by fungi or highly resistant organisms (Class I; Level of Evidence B). 5. Early surgery is reasonable for patients with PVE who have recurrent emboli despite appropriate anti- biotic treatment (Class IIa; Level of Evidence B). 6. Early surgery is reasonable for patients with relaps- ing PVE (Class IIa; Level of Evidence C). 7. Early surgery may be considered in patients with mobile vegetations >10 mm (Class IIb; Level of Evidence C). Valve Surgery in Patients With Right-Sided IE Although outcomes are better for patients with right-sided IE compared with patients with left-sided infection, surgi- cal intervention is occasionally considered in the former group. Because many of the patients with right-sided IE develop infection as a result of IDU (see the Right-Sided IE in IDUs section), the general approach is to treat these patients Table 17. 