Dental Screening Prior to Valve Interventions; Should We Prepare TAVR Patients for "Surgery"?

haitham sholy Cardiovascular Department, B Padeh Medical Center, Poria-Lower Galilee, Israel The Faculty of Medicine, Bar-Ilan University, Zefat, Israel Dalit Porat Ben Amy Cardiovascular Department, B Padeh Medical Center, Poria-Lower Galilee, Israel The Faculty of Medicine, Bar-Ilan University, Zefat, Israel Nizar Andria Cardiovascular Department, B Padeh Medical Center, Poria-Lower Galilee, Israel The Faculty of Medicine, Bar-Ilan University, Zefat, Israel Ghanim Diab Cardiovascular Department, B Padeh Medical Center, Poria-Lower Galilee, Israel The Faculty of Medicine, Bar-Ilan University, Zefat, Israel Doron Sudarsky Cardiovascular Department, B Padeh Medical Center, Poria-Lower Galilee, Israel The Faculty of Medicine, Bar-Ilan University, Zefat, Israel Wadi Kinany Cardiovascular Department, B Padeh Medical Center, Poria-Lower Galilee, Israel The Faculty of Medicine, Bar-Ilan University, Zefat, Israel Khaled Taha Cardiovascular Department, B Padeh Medical Center, Poria-Lower Galilee, Israel The Faculty of Medicine, Bar-Ilan University, Zefat, Israel Chen Shmuel Cardiovascular Department, B Padeh Medical Center, Poria-Lower Galilee, Israel The Faculty of Medicine, Bar-Ilan University, Zefat, Israel David Meerkin Cardiovascular Department, B Padeh Medical Center, Poria-Lower Galilee, Israel The Faculty of Medicine, Bar-Ilan University, Zefat, Israel Imad Abu El-Naaj Cardiovascular Department, B Padeh Medical Center, Poria-Lower Galilee, Israel The Faculty of Medicine, Bar-Ilan University, Zefat, Israel Kachel Erez Cardiovascular Department, B Padeh Medical Center, Poria-Lower Galilee, Israel The Faculty of Medicine, Bar-Ilan University, Zefat, Israel Sammer Diab Cardiovascular Department, B Padeh Medical Center, Poria-Lower Galilee, Israel The Faculty of Medicine, Bar-Ilan University, Zefat, Israel Offer Amir Cardiovascular Department, B Padeh Medical Center, Poria-Lower Galilee, Israel The Faculty of Medicine, Bar-Ilan University, Zefat, Israel Carasso Shemy Cardiovascular Department, B Padeh Medical Center, Poria-Lower Galilee, Israel The Faculty of Medicine, Bar-Ilan University, Zefat, Israel Fabio Kusniec Cardiovascular Department, B Padeh Medical Center, Poria-Lower Galilee, Israel The Faculty of Medicine, Bar-Ilan University, Zefat, Israel

Background 40% of cases of infective endocarditis {IE} are caused by oral bacteria. Albeit IE after Transcatheter aortic valve replacement (TAVR) is comparable to IE following surgical prosthetic valve surgery , Israeli and international guidelines recommend only the surgical candidates to have a dental screening prior to their operation while no specific recommendations exist regarding dental screening prior to TAVR.

Our own institutional practice is to have dental screening to all TAVR patients precisely as done prior to all valve surgery candidates.

The purpose of this study was to evaluate our policy by comparing the oral dental findings in our TAVR candidates with thoese of the surgical ones and thereby assessing the need to submit all the TAVR candidates to a "surgical assessment" of their dental status and consequential needed treatments for IE prevention.

Methods 180 patients(70 TAVR candidates and 110 surgical candidates) were all screened prior to their intervention by our Oral Medicine unit team and were treated accordingly to prevent IE. The Oral Medicine team was blinded to the planned interventional treatment (i.e. surgery or TAVR) and was asked to follow in all patients the routine dental pre-surgery valve protocol. All patients were scored for oral hygiene and dental findings which required intervention.

Results Although surgical patients were younger than TAVR one (mean age of 66 vs. 81 respectively, P<0.0001), there was no significant difference in the dental findings. Of note 31 patients (44%) of TAVR’s candidates had dental findings which required dental intervention prior to the TAVR procedure, while in the surgical group 62 patients 56% of patients had similar findings. (p=0.1) ( Table 1).

Conclusion Dental findings and related pre-TAVR dental treatments are as common as in surgical valve surgery. Accordingly, TAVR candidates may require dental assessment and treatment in identical protocol as to surgical candidates.

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Presentation

haitham sholy