In view of the severity of infective endocarditis, which is due to local and general infectious processes and the hemodynamic consequences of valvular destruction, a policy of earlier valve replacement has been adopted. Clinical, bacteriologic and pathologic data collected over two years suggest that early surgery can be recommended in the following cases: congestive heart failure, inadequate results of antimicrobial therapy, and multiple emboli. Further studies should validate this policy, but the necessity of general prophylaxis for infective endocarditis must always be borne in mind.