Infective endocarditis is a rare disease associated with significant morbidity and mortality. In the past decades, there have been significant improvements in the management of infective endocarditis. Complications are frequent and include heart failure, embolic episodes, periannular complications, and central nervous system events. Surgical therapy has been fundamental in the reduction of mortality in complicated cases. This paper is an overview of the main complications of native and prosthetic infective endocarditis and its treatment.