Summary Preoperative dental screening before heart valve surgery is widely accepted, but its required extent remains unclear. This study evaluates two preoperative dental screening (PDS) approaches, a focused approach (FocA) and a comprehensive approach (CompA), to compare 90-day postsurgical mortality. A retrospective cohort analysis was performed on all patients who underwent valvular surgery at Brigham and Women’s Hospital with FocA and Massachusetts General Hospital with CompA PDS approach from January 2009 to December 2016. Patients with abuse were excluded. of intravenous drugs and systemic infections. A univariate, multivariate and subgroup analysis was performed. Results A total of 1,835 patients were included in the study. With FocA, 96% of patients (1097/1143) received dental clearance in a single encounter and 3.3% received x-rays and underwent dental extractions. With CompA, 35.5% of patients (245/692) received dental clearance in a single encounter, 94.2% received x-rays, and 21.8% underwent dental extractions. There was no significant difference in 90-day mortality when comparing both PDS approaches (10% versus 8.4%, P = 0.257). This remained unchanged in a multivariable model after adjusting for risk factors (odds ratio: 1.32 [95% CI: 0.91 to 1.93] [p = 0.14]). Reoperation for infection was lower in FocA (0.5%) versus CompA (2.6) (p < 0.001) and postoperative sepsis increased in the FocA cohort (1.7%) compared to CompA (0.7 %) (p <0.001) ) patients. Conclusions There was no difference in 90-day mortality after valve surgery between patients undergoing FocA versus CompA of PDS. |
Results of their experience regarding preoperative dental screening before heart valve surgery and the postoperative mortality observed at 90 days in these patients, according to the strategy used.
Cardiovascular disease is the single largest contributor to global mortality, accounting for more than 31% of all deaths.
Of all cardiovascular diseases, valvular heart disease (VHD) is one of the important contributors that is often reported to have catastrophic complications.
The option of choice for most VHD is surgical valve replacement with bioprosthetic or mechanical valves.
Despite technological advances and surgical techniques, postsurgical complications, including infections, remain a major problem contributing to morbidity and mortality.
Post-surgical valve infections (including those developed by surgery and those resulting from valve replacement), although relatively rare, with an incidence ranging between 1% and 6%, are of great concern due to the associated comorbidities and early mortality.
It is widely accepted that odontogenic infections can be the source of valvular infection with evidence from reports identifying oral bacteria in the infected endocardium.
As a result, preoperative dental screening (PDS) is recommended to identify and eliminate possible oral sources of infection before valve surgery to reduce the risk of infections and early mortality.
Since there is no defined PDS protocol or guideline in the literature, some dental practices focus on treating only symptomatic oral infections, while others treat both symptomatic and asymptomatic oral infections before surgery.
The magnitude of benefits and adverse effects of different PDS approaches on postvalvular complications and early mortality remains unclear.
Therefore, the objective of this study was to evaluate the association of two different PDS approaches with 90-day mortality after valve surgery, a focused criterion (FocA) and a comprehensive approach (CompA), to compare postsurgical mortality. 90 days.
A retrospective cohort analysis was performed on all patients who underwent valve surgery at Brigham and Women’s Hospital using the FocA approach and Massachusetts General Hospital using the CompA approach from January 2009 to December 2009. 2016.
Patients with intravenous drug abuse and systemic infections were excluded. A univariate, multivariate and subgroup analysis was performed.
A total of 1,835 patients were included in the study .
With FocA, 96% of patients (1097/1143) received dental clearance in a single encounter and 3.3% had x-rays and dental extractions.
Applying the CompA strategy, 35.5% of patients (245/692) received dental authorization to perform surgery in a single encounter, 94.2% underwent x-rays and 21.8% underwent extractions. dental.
There was no significant difference in 90-day mortality when both PDS approaches were compared (10% vs. 8.4%, p = 0.257). This remained unchanged in a multivariable model after adjusting for risk factors (odds ratio: 1.32 [95% CI: 0.91-1.93] [p = 0.14]).
Reoperation due to infection was lower in the FocA group (0.5%) compared to CompA (2.6) (p < 0.001) and postoperative sepsis increased in the FocA cohort (1.7%) compared to CompA (0.001). .7%) (p <0.001)) patients.
In conclusion , the authors state that there was no difference in mortality at 90 days after valve surgery between patients undergoing FocA vs CompA PDS strategies.
