“Every long march begins with the first step.” Laotse, Dao-de-dsching, chapter 46 Infective endocarditis is a cardiac disease whose hospital mortality with staphylococcus or enterococcus is exceeded only by cardiogenic shock. In a recently published Danish survey, hospital mortality is 28 %. [ 1 ] It is all the more astonishing that both because of the high mortality and although the incidence of the disease is increasing, the therapeutic armamentarium has not changed in recent decades. In a European survey, an indication for surgery according to European and US guidelines exists in 69 % of patients, but only 50 % of these patients are ultimately operated on, either because the patients die beforehand or are classified as inoperable [ 2 ]. The indication for surgery in infective endocarditis has also remained unchanged for decades: - when hemodynamic instability is present (usually due to severe valvular insufficiency), - when the infection cannot be controlled or when there are floating vegetations greater than 1 cm, - usually after staphylococcal or enterococcal infection- as these lead to cerebral emboli in 20 or 40 % of cases [ 2 ]. Only the spectrum of pathogens has changed in the last decades, earlier streptococci now the more dangerous staphylococci and enterococci make up the majority of cases [ 3 ]. The increase in the number of cases is due on the one hand to be more frequent, especially of the tricuspid valve in drug addicts, and on the other hand to the increasing aging of patients and the associated higher incidence of pre-damaged or prosthetic valves. Infection rates after both catheter-guided aortic valves (TAVI) or surgical valve replacement continue to have an incidence of 1.4–1.9 % per year, with the earlier treated by re-operation having a 1-year mortality of 60–65 % [ 4 , 5 ].