Oral surgical management of patients with mechanical circulatory support

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.