Concomitant surgical treatment of dental and valvular heart diseases.
BACKGROUND
Invasive dental procedures are often indicated before cardiac valve surgery. The purpose of this case-control study was to determine the risks and benefits of concomitant dental and thoracic surgery.


METHODS
Critically ill cardiac inpatients requiring cardiac valve surgery were referred by the Department of Thoracic and Cardiovascular Surgery to our Oral Medicine consult service. Those requiring dental extractions were considered for dental treatment during the same general anesthetic as the cardiac surgery. These study patients were compared with control patients who had extractions before valve surgery in a different setting. There was no attempt to analyze the impact of this practice on the development of infective endocarditis. All patients received broad-spectrum antibiotics during dental surgery.


RESULTS
Twenty-one patients had concomitant oral and cardiac valve surgery. Seventeen patients were in the control group. There were no statistically significant differences between cases and controls in demographics, length of stay, nature of the dental surgery, mean number of teeth removed, oral bleeding, or postoperative infections. One patient in the control group developed prosthetic valve endocarditis versus none in the concomitant surgery group.


CONCLUSIONS
This case-control study suggests that concomitant surgical procedures for dental and valvular heart disease can be accomplished without clinically significant oral complications. Given the risk from poor oral health following cardiac valve surgery, this approach should be considered for patients who would benefit by avoiding a second general anesthetic and/or a delay in cardiac surgery, and by having their oral surgery performed in the safest environment.
Lockhart
Peter B
PB
Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC 28232-2861, USA. Peter.Lockhart@carolinashealthcare.org
Brennan
Michael T
MT
Cook
William H
WH
Sasser
Howell
H
Lovell
Roger D
RD
Skipper
Eric R
ER
Noll
Jenene
J
Cox
Timothy L
TL
Aten
Deborah J
DJ
Cook
Joseph W
JW
D019072:Antibiotic Prophylaxis; D006348:Cardiac Surgical Procedures; D016022:Case-Control Studies; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome