With much interest we read the recent article of Funakoshi and colleagues,1 suggesting superior long-term outcomes for patients with infective endocarditis after early surgical treatment relative to a purported conventional treatment strategy. Although the results seem in line with general consensus, several meth-odologic issues arise, affecting the validity of the study's conclusions. First, we would like to comment on the definition of the study groups. The conventional treatment group includes patients who have been treated with antibiotics only, as well as patients who have been operated on at a later stage. In our opinion, these patients should not be combined into a single treatment group. To illustrate this, the in-hospital mortality is 5% for both the early and late surgical groups.
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