Impact of mandatory preoperative dental screening on post-procedural risk of infective endocarditis in patients undergoing transcatheter aortic valve implantation: a nationwide retrospective observational study

Lytfi Krasniqi; Lars Peter Schødt Riber; Henrik Nissen; Christian Juhl Terkelsen; Niels Holmark Andersen; Phillip Freeman; Jonas A Povlsen; Oke Gerke; Marie-Annick Clavel; Jordi Sanchez Dahl

doi:10.1016/j.lanepe.2023.100789

Impact of mandatory preoperative dental screening on post-procedural risk of infective endocarditis in patients undergoing transcatheter aortic valve implantation: a nationwide retrospective observational study

Lytfi Krasniqi, Lars Peter Schødt Riber, Henrik Nissen, Christian Juhl Terkelsen, Niels Holmark Andersen, Phillip Freeman, Jonas A Povlsen, Oke Gerke, Marie-Annick Clavel, Jordi Sanchez Dahl

Institut for Klinisk Medicin - Hjertesygdomme

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

Abstract

BACKGROUND: Guidelines recommend preoperative dental screening (PDS) prior to cardiac valve surgery, to reduce the incidence of prosthetic valve infective endocarditis (IE). However, limited data support these recommendations, particular in patients undergoing transcatheter aortic valve implantation (TAVI). We aimed to investigate the effect of mandatory PDS on risk of IE in patients undergoing TAVI.

METHODS: In this observational study, a total of 1133 patients undergoing TAVI in Western-Denmark from 2020 to 2022 were included. Patients were categorized based on two implemented PDS practices: mandatory PDS (MPDS group), and no referral for PDS (NPDS group). Outcome data were retrieved from Danish registries and confirmed using medical records. The primary outcome was incidence of IE. Secondary outcomes were all-cause mortality and composite outcome of all-cause mortality and IE.

FINDINGS: Of 568 patients in the MPDS group 126 (22.2%) underwent subsequent oral dental surgery, compared to 8 (1.4%) among 565 patients in the NPDS group. During a median follow-up of 1.9 years (interquartile range 1.4-2.5 years), 31 (2.7%) developed IE. The yearly incidence IE rate was 1.4% (0.8-2.3) and 1.5% (0.8-2.4) in MPDS and NPDS, respectively, p = 0.86. All-cause mortality rates were similar between groups (estimated 2-year overall mortality of 6.7% (4.8-9.2) vs. 4.7% (3.2-6.9), MPDS and NPDS, respectively, p = 0.15). Consistent findings were found in 712 propensity score-matched patients.

INTERPRETATION: Mandatory PDS did not demonstrate reduced risk of IE or all-cause mortality compared to targeted PDS in patients undergoing TAVI.

FUNDING: The funder had no role in the study design, data management, or writing.

Originalsprog	Engelsk
Artikelnummer	100789
Tidsskrift	The Lancet Regional Health - Europe
Vol/bind	36
ISSN	2666-7762
DOI	https://doi.org/10.1016/j.lanepe.2023.100789
Status	Udgivet - jan. 2024

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Citationsformater

Krasniqi, L., Schødt Riber, L. P., Nissen, H., Terkelsen, C. J., Andersen, N. H., Freeman, P., Povlsen, J. A., Gerke, O., Clavel, M.-A., & Dahl, J. S. (2024). Impact of mandatory preoperative dental screening on post-procedural risk of infective endocarditis in patients undergoing transcatheter aortic valve implantation: a nationwide retrospective observational study. The Lancet Regional Health - Europe, 36, Artikel 100789. https://doi.org/10.1016/j.lanepe.2023.100789

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title = "Impact of mandatory preoperative dental screening on post-procedural risk of infective endocarditis in patients undergoing transcatheter aortic valve implantation: a nationwide retrospective observational study",

abstract = "BACKGROUND: Guidelines recommend preoperative dental screening (PDS) prior to cardiac valve surgery, to reduce the incidence of prosthetic valve infective endocarditis (IE). However, limited data support these recommendations, particular in patients undergoing transcatheter aortic valve implantation (TAVI). We aimed to investigate the effect of mandatory PDS on risk of IE in patients undergoing TAVI.METHODS: In this observational study, a total of 1133 patients undergoing TAVI in Western-Denmark from 2020 to 2022 were included. Patients were categorized based on two implemented PDS practices: mandatory PDS (MPDS group), and no referral for PDS (NPDS group). Outcome data were retrieved from Danish registries and confirmed using medical records. The primary outcome was incidence of IE. Secondary outcomes were all-cause mortality and composite outcome of all-cause mortality and IE.FINDINGS: Of 568 patients in the MPDS group 126 (22.2%) underwent subsequent oral dental surgery, compared to 8 (1.4%) among 565 patients in the NPDS group. During a median follow-up of 1.9 years (interquartile range 1.4-2.5 years), 31 (2.7%) developed IE. The yearly incidence IE rate was 1.4% (0.8-2.3) and 1.5% (0.8-2.4) in MPDS and NPDS, respectively, p = 0.86. All-cause mortality rates were similar between groups (estimated 2-year overall mortality of 6.7% (4.8-9.2) vs. 4.7% (3.2-6.9), MPDS and NPDS, respectively, p = 0.15). Consistent findings were found in 712 propensity score-matched patients.INTERPRETATION: Mandatory PDS did not demonstrate reduced risk of IE or all-cause mortality compared to targeted PDS in patients undergoing TAVI.FUNDING: The funder had no role in the study design, data management, or writing.",

keywords = "Infectious endocarditis, Preoperative dental screening, TAVI",

author = "Lytfi Krasniqi and {Sch{\o}dt Riber}, {Lars Peter} and Henrik Nissen and Terkelsen, {Christian Juhl} and Andersen, {Niels Holmark} and Phillip Freeman and Povlsen, {Jonas A} and Oke Gerke and Marie-Annick Clavel and Dahl, {Jordi Sanchez}",

note = "{\textcopyright} 2023 The Author(s).",

year = "2024",

month = jan,

doi = "10.1016/j.lanepe.2023.100789",

language = "English",

volume = "36",

journal = "The Lancet Regional Health - Europe",

issn = "2666-7762",

publisher = "Elsevier",

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Krasniqi, L, Schødt Riber, LP, Nissen, H, Terkelsen, CJ, Andersen, NH, Freeman, P, Povlsen, JA, Gerke, O, Clavel, M-A & Dahl, JS 2024, 'Impact of mandatory preoperative dental screening on post-procedural risk of infective endocarditis in patients undergoing transcatheter aortic valve implantation: a nationwide retrospective observational study', The Lancet Regional Health - Europe, bind 36, 100789. https://doi.org/10.1016/j.lanepe.2023.100789

Impact of mandatory preoperative dental screening on post-procedural risk of infective endocarditis in patients undergoing transcatheter aortic valve implantation: a nationwide retrospective observational study. / Krasniqi, Lytfi; Schødt Riber, Lars Peter; Nissen, Henrik et al.
I: The Lancet Regional Health - Europe, Bind 36, 100789, 01.2024.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Impact of mandatory preoperative dental screening on post-procedural risk of infective endocarditis in patients undergoing transcatheter aortic valve implantation

T2 - a nationwide retrospective observational study

AU - Krasniqi, Lytfi

AU - Schødt Riber, Lars Peter

AU - Nissen, Henrik

AU - Terkelsen, Christian Juhl

AU - Andersen, Niels Holmark

AU - Freeman, Phillip

AU - Povlsen, Jonas A

AU - Gerke, Oke

AU - Clavel, Marie-Annick

AU - Dahl, Jordi Sanchez

PY - 2024/1

Y1 - 2024/1

N2 - BACKGROUND: Guidelines recommend preoperative dental screening (PDS) prior to cardiac valve surgery, to reduce the incidence of prosthetic valve infective endocarditis (IE). However, limited data support these recommendations, particular in patients undergoing transcatheter aortic valve implantation (TAVI). We aimed to investigate the effect of mandatory PDS on risk of IE in patients undergoing TAVI.METHODS: In this observational study, a total of 1133 patients undergoing TAVI in Western-Denmark from 2020 to 2022 were included. Patients were categorized based on two implemented PDS practices: mandatory PDS (MPDS group), and no referral for PDS (NPDS group). Outcome data were retrieved from Danish registries and confirmed using medical records. The primary outcome was incidence of IE. Secondary outcomes were all-cause mortality and composite outcome of all-cause mortality and IE.FINDINGS: Of 568 patients in the MPDS group 126 (22.2%) underwent subsequent oral dental surgery, compared to 8 (1.4%) among 565 patients in the NPDS group. During a median follow-up of 1.9 years (interquartile range 1.4-2.5 years), 31 (2.7%) developed IE. The yearly incidence IE rate was 1.4% (0.8-2.3) and 1.5% (0.8-2.4) in MPDS and NPDS, respectively, p = 0.86. All-cause mortality rates were similar between groups (estimated 2-year overall mortality of 6.7% (4.8-9.2) vs. 4.7% (3.2-6.9), MPDS and NPDS, respectively, p = 0.15). Consistent findings were found in 712 propensity score-matched patients.INTERPRETATION: Mandatory PDS did not demonstrate reduced risk of IE or all-cause mortality compared to targeted PDS in patients undergoing TAVI.FUNDING: The funder had no role in the study design, data management, or writing.

AB - BACKGROUND: Guidelines recommend preoperative dental screening (PDS) prior to cardiac valve surgery, to reduce the incidence of prosthetic valve infective endocarditis (IE). However, limited data support these recommendations, particular in patients undergoing transcatheter aortic valve implantation (TAVI). We aimed to investigate the effect of mandatory PDS on risk of IE in patients undergoing TAVI.METHODS: In this observational study, a total of 1133 patients undergoing TAVI in Western-Denmark from 2020 to 2022 were included. Patients were categorized based on two implemented PDS practices: mandatory PDS (MPDS group), and no referral for PDS (NPDS group). Outcome data were retrieved from Danish registries and confirmed using medical records. The primary outcome was incidence of IE. Secondary outcomes were all-cause mortality and composite outcome of all-cause mortality and IE.FINDINGS: Of 568 patients in the MPDS group 126 (22.2%) underwent subsequent oral dental surgery, compared to 8 (1.4%) among 565 patients in the NPDS group. During a median follow-up of 1.9 years (interquartile range 1.4-2.5 years), 31 (2.7%) developed IE. The yearly incidence IE rate was 1.4% (0.8-2.3) and 1.5% (0.8-2.4) in MPDS and NPDS, respectively, p = 0.86. All-cause mortality rates were similar between groups (estimated 2-year overall mortality of 6.7% (4.8-9.2) vs. 4.7% (3.2-6.9), MPDS and NPDS, respectively, p = 0.15). Consistent findings were found in 712 propensity score-matched patients.INTERPRETATION: Mandatory PDS did not demonstrate reduced risk of IE or all-cause mortality compared to targeted PDS in patients undergoing TAVI.FUNDING: The funder had no role in the study design, data management, or writing.

KW - Infectious endocarditis

KW - Preoperative dental screening

KW - TAVI

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U2 - 10.1016/j.lanepe.2023.100789

DO - 10.1016/j.lanepe.2023.100789

M3 - Journal article

C2 - 38188272

SN - 2666-7762

VL - 36

JO - The Lancet Regional Health - Europe

JF - The Lancet Regional Health - Europe

M1 - 100789

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Krasniqi L, Schødt Riber LP, Nissen H, Terkelsen CJ, Andersen NH, Freeman P et al. Impact of mandatory preoperative dental screening on post-procedural risk of infective endocarditis in patients undergoing transcatheter aortic valve implantation: a nationwide retrospective observational study. The Lancet Regional Health - Europe. 2024 jan.;36:100789. doi: 10.1016/j.lanepe.2023.100789