Preoperative dental screening prior to cardiac valve surgery and 90‐day postoperative mortality

Abstract

Background: Preoperative dental screening before cardiac valve surgery is widely accepted but its required scope remains unclear. This study evaluates two preoperative dental screening (PDS) approaches, a focused approach (FocA) and a comprehensive approach (CompA), to compare postsurgical 90-day mortality. Methods: Retrospective cohort analysis was performed on all patients who underwent valve surgery at Brigham and Women's Hospital with FocA and Massachusetts General Hospital with CompA of PDS approach from January 2009 to December 2016. Patients with intravenous drug abuse and systemic infections were excluded. Univariate, multivariable, and subgroup analysis was performed. Results: A total of 1835 patients were included in the study. With FocA 96% of patients (1097/1143) received dental clearance in a single encounter with 3.3% receiving radiographs and undergoing dental extractions. With CompA 35.5% of patients (245/692) received dental clearance in a single encounter, 94.2% received radiographs, and 21.8% underwent dental extractions. There was no significant difference in 90-day mortality when comparing both PDS approach (10% vs 8.4%, P = .257). This remained unchanged in a multivariable model after adjusting for risk factors (odds ratio:1.32 [95%CI:0.91-1.93] [P = .14]). Reoperation due to infection was less in FocA (0.5%) vs CompA (2.6) (P < .001) and postoperative septicemia was increased in the FocA (1.7%) cohort when compared to the CompA (0.7%) (P < .001) patients. Conclusions: There was no difference in post valve surgery 90-day mortality between patients who underwent a FocA vs CompA of PDS.

Oral bacteria in infective endocarditis requiring surgery: a retrospective analysis of 134 patients

“…In their study, the mean age of patients was 60 ± 15 years (range 18–92 years), which is close to the demographic data of culture-positive IE patients in this study (63.2 ± 13.8, range 25–91 years). Comparable results were also found by Oliveira et al [ 19 ] and Rao et al [ 21 ] reporting that more male than female individuals underwent cardiac valve surgery (54.8% versus 45.2% and 58.9% versus 41.8%, respectively). Accordingly, the present study population is comparable to similar study population groups in terms of gender and mean age and may be considered as representative.…”

Dental and oral management in the perioperative period of surgery: A scoping review

“…There were three SRs, one RCT, and five observational studies [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] . An SR by Wei et al [44] and Bardia et al [45] examined the incidence of postoperative pneumonia and nosocomial infections between patients who underwent oral rinsing with chlorhexidine and those who underwent rinsing with other drugs or no rinsing.…”

“…In the observational studies, Suzuki et al [51] reported significantly fewer days of postoperative fever-up in heart valve surgery patients who received periodontal therapy before surgery than in those who did not (risk of bias; moderate). Rao et al [50] compared early postoperative mortality in heart valve surgery patients treated with a comprehensive versus a focused dental approach and found no significant difference between them (risk of bias; moderate). Bergan et al [52] compared the incidence of postoperative pneumonia between groups with and without improvement in oral hygiene and reported significantly less postoperative pneumonia in the group with an improved oral hygiene (risk of bias; moderate).…”

Transplante Dentário Autógeno: Uma Abordagem Na Odontopediatria

“…Os estudos demonstram que ainda não existe um protocolo padrão estabelecido para o atendimento odontológico direcionado a pacientes que serão submetidos a cirurgias cardíacas, como também mostra o estudo de Cotti et al (2019). Extrações de dentes infeccionados no pré-operatório de cirurgia cardíaca são indicadas com certa frequência para diminuir os riscos de infecções sistêmicas importantes (RAO et al, 2020; pacientes antes e depois da cirurgia, desta forma, pacientes que tem todos os focos infecciosos eliminados apresentam febre durante menos dias (SUZUKI et al, 2019;RAO et al, 2020).…”