Effect of dental treatment before cardiac valve surgery: Systematic review and meta-analysis

The purpose of this systematic review was to determine the potential effect of dental treatment before cardiac valve surgery (CVS) or left ventricular assist device (LVAD) implantation on morbidity and mortality.

The authors included relevant studies from MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials, including randomized controlled trials and cohort studies, published from 1998 through 2019 and involving adults who received dental treatment before CVS or LVAD implantation. The authors assessed bias by using the Newcastle-Ottawa Quality Assessment Scale and evidence certainty by using the Grading of Recommendations Assessment, Development and Evaluation approach. The authors used a meta-analysis with a random-effects model to estimate dichotomous and continuous outcomes, expressed as relative risk (RR) and weighted mean difference.

Six studies met the inclusion criteria for CVS but none for LVAD implantation. Very low certainty in the evidence suggested uncertainty as to whether health outcomes for patients undergoing dental treatment before CVS differed from those who did not. Postsurgical outcomes included all-cause mortality (RR, 1.00; 95% confidence interval [CI], 0.53 to 1.91), infective endocarditis (RR, 1.30; 95% CI, 0.51 to 3.35), postsurgical infection (RR, 1.01; 95% CI, 0.76 to 1.33), and length of stay in the hospital (weighted mean difference, 2.9; 95% CI, -2.3 to 8.1).

From the available evidence, it is unclear whether postoperative outcomes differ in patients receiving dental treatment before CVS compared with outcomes in those who do not. Dentists and medical care professionals should collaborate on an appropriate course of action for each patient, weighing any potentially relevant care considerations.