Poor Heart Surgery Outcome Linked to Dental Extractions

Among candidates for heart surgery, abscessed or infected teeth often are removed prior to surgery, in an aim to reduce the risk of infections including endocarditis, an infection of the inner lining of the heart that can prove deadly. Prosthetic heart valve-related endocarditis accounts for up to one-fourth of infective endocarditis cases and proves fatal for up to 38 of patients who develop it. Kendra Grim, from Mayo Clinic (Minnesota, USA), and colleagues completed the largest so far evaluating adverse outcomes after pre-cardiac surgery dental extractions. The researchers studied outcomes in 205 adult Mayo patients who had teeth pulled before cardiovascular surgery. 80% of the patients were men, the median age at the time of tooth extraction was 62 years, and the median time lapse between dental extraction and heart surgery was seven days. Six patients, or 3%, died in the period between their tooth extraction and the planned cardiac procedure.  Another six died after heart surgery, all while still hospitalized.  Ten patients, or roughly 5%, had other major adverse outcomes after heart surgery, such as bleeding, stroke, kidney failure requiring dialysis, acute coronary syndrome or stroke-like transient ischemic attacks.  The study authors warn that: “Patients with planned dental extraction before cardiac operation are at risk for major adverse outcomes, including a 3% risk of death before cardiac operation and an 8% risk of a major adverse outcome.”