Rates of recurrent postoperative endocarditis after valve replacement in acute infective endocarditis are high. Metallic silver coating of the sewing ring may improve short- and long-term outcome after valve implantation. This report details results with the St. Jude Medical Silzone^TM prosthesis in surgical treatment of acute infective endocarditis. Ten patients (mean age 66.4 years) referred for native valve or prosthetic valve endocarditis were operated on between April 1998 and June 1999. The causative microorganisms were Staphylococcus (n = 1), Streptococcus (n = 1) and Pseudomonas aeruginosa (n = 1); blood cultures remained negative in two cases. The indication for surgery was related to hemodynamic condition (n = 5), a major cerebral event (stroke; n = 1), annulus abscess (n = 1), and echocardiographic evidence of large cuspal vegetations (n = 3). Four mitral valve and five aortic valve replacements, and one double mitral-aortic valve replacement, were performed after debridement of infected and necrotic tissues. Postoperative antibiotic treatment was for 32.3 days. Postoperative follow up was 100% complete, and included transthoracic echocardiography at one week, and one, six and 12 months. One patient died early in the immediate postoperative period; all other patients were symptom-free, without evidence of recurrent infection and perivalvular leak. These results with the St. Jude Medical Silzone prosthesis should be confirmed by further studies, but infer that silver coating of the sewing ring may dramatically improve management of patients with active endocarditis.