title: Oral surgical management of patients with mechanical circulatory support.
abstract: After the introduction of mechanical circulatory support (MCS) for treatment of patients with severe cardiogenic shock, the survival rate of these patients increased significantly. Temporary MCS may be applied over a period of several days up to months prior to heart transplantation (HTx). Oral surgical management of patients with MCS is seriously complicated by a combination of anticoagulant and antiaggregant medication. Moreover, contact of blood with artificial surfaces, i.e. polyurethane and silicone, may increase the risk of thromboembolic events and infections. A total of 32 patients with MCS (29 men and three women with a median age 48 years [range 27-60 years]) were examined for odontogenic foci, treatment needs and local and cardiovascular complications after oral surgical intervention. In 27 patients (84%) at least one potential focus was diagnosed. Following tooth extraction 4 out of 6 patients presented with local haemorrhage (n=3) and thromboembolic events (n=2). Generally MCS has to be considered a relative contraindication for elective oral surgical interventions.
authors.affiliation: Department of Oral Surgery and Dental Radiology, Charitè, Humboldt University, Berlin, Germany. j.lund@charite.de
authors.forename: J P
authors.initials: JP
authors.lastname: Lund
authors.forename: T
authors.initials: T
authors.lastname: Drews
authors.forename: R
authors.initials: R
authors.lastname: Hetzer
authors.forename: P A
authors.initials: PA
authors.lastname: Reichart
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001672:Biocompatible Materials / Q000737:chemistry; D000075202:Contraindications; D017558:Elective Surgical Procedures; D005260:Female; D005491:Focal Infection, Dental / Q000601:surgery; D006353:Heart-Assist Devices; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D008964:Molar, Third / Q000601:surgery; D020380:Needs Assessment; D006472:Oral Hemorrhage / Q000209:etiology; D019647:Oral Surgical Procedures / Q000009:adverse effects / Q000379:methods; D010485:Periapical Periodontitis / Q000601:surgery; D010518:Periodontitis / Q000601:surgery; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011140:Polyurethanes / Q000737:chemistry; D011446:Prospective Studies; D012307:Risk Factors; D012828:Silicones / Q000737:chemistry; D013499:Surface Properties; D013530:Surgical Wound Infection / Q000209:etiology; D015996:Survival Rate; D013923:Thromboembolism / Q000209:etiology; D014081:Tooth Extraction / Q000009:adverse effects; D014095:Tooth, Impacted / Q000601:surgery
chemical_list: D000925:Anticoagulants; D001672:Biocompatible Materials; D010975:Platelet Aggregation Inhibitors; D011140:Polyurethanes; D012828:Silicones; D006493:Heparin