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Heart failure | Surgical Timing |
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Aortic or mitral NVE or PVE with severe acute regurgitation, obstruction or fistula causing refractory pulmonary oedema or cardiogenic shock | Emergency (Class I - Level of recommendation B) |
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Aortic or mitral NVE or PVE with severe regurgitation or obstruction causing symptoms of HF or echocardiographic signs of poor haemodynamic tolerance | Urgent (Class I - Level of recommendation B) |
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Uncontrolled infection | |
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Locally uncontrolled infection (abscess, false aneurysm, fistula, enlarging vegetation) | Urgent (Class I - Level of recommendation B) |
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Infection caused by fungi or multiresistant organisms | Urgent/Elective (Class I - Level of recommendation C) |
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Persisting positive blood cultures despite appropriate antibiotic therapy and adequate control of septic metastatic foci | Urgent (Class II - Level of recommendation A) |
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PVE caused by staphylococci or non-HACEK gram-negative bacteria | Urgent/Elective (Class II - Level of recommendation A) |
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Prevention of embolism | |
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Aortic or mitral NVE or PVE with persistent vegetation >10 mm after one or more embolic episode despite appropriate antibiotic therapy | Urgent (Class I - Level of recommendation B) |
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Aortic or mitral NVE with vegetation >10 mm, associated with severe valve stenosis or regurgitation, and low operative risk | Urgent (Class II - Level of recommendation A) |
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Aortic or mitral NVE or PVE with isolated very large vegetation (> 30 mm) | Urgent (Class II - Level of recommendation A) |
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Aortic or mitral NVE or PVE with isolated large vegetation (>15 mm) and no other indication for surgery | Urgent (Class II - Level of recommendation B) |
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