Congestive heart failure following infective endocarditis in hemodialysis patients has been uniformly fatal in patients treated with antibiotics alone. Thirteen patients on chronic hemodialysis have undergone replacement of the infected valve with an overall survival of 61%. The aortic valve was involved in 10 patients and Staphylococcus aureus the responsible organism in nine. Recurrent bacteremia occurred in two of the eight long-term survivors and was successfully treated with antibiotics in one patient and replacement of the prosthesis in the other. The surgical treatment of infective endocarditis in the hemodialysis patient is an acceptable mode of therapy and its application should not be hindered by reservations concerning operative feasibility or postoperative longevity. As in non-dialysis patients with infective endocarditis and congestive heart failure early operative intervention may substantially improve survival.