The definition of IE was based on the 2015 European Society of Cardiology algorithm for diagnosis of infective endocarditis [4], which mainly includes the pathological diagnostic criteria and the modified Duke criteria.

Pathological examination served as the gold standard for IE diagnosis and had to meet at least one of the following criteria: microorganisms demonstrated by culture or histological examination of a vegetation; a vegetation that has embolized or an intracardiac abscess specimen; or the presence of pathological lesions, vegetation, or intracardiac abscesses by histological examination showing active endocarditis. Pathologists were blinded to clinical parameters and echocardiographic results when diagnosing vegetation samples [4].

The modified Duke criteria (adapted from Li et al. [5]) were used to clinically diagnose cases classified as either definite or suspected. Three echocardiographic findings are the major criteria in IE diagnosis: vegetation, abscess, or pseudoaneurysm and new dehiscence of a prosthetic valve [7]. The echocardiographic definitions are listed in the Additional file 1.

Surgery was performed during the course of the appropriate antimicrobial therapy and was indicated for at least one of the following conditions, which were in accordance with the current guidelines [4, 10]: severe valvular dysfunction in the presence of heart failure, abscess or perivalvular extension, large vegetations at high risk of embolization (or recurrent embolization during antibiotic treatment), and failure of conservative medical treatment.

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