Pulling infected teeth before heart surgery may be catch-22

ROCHESTER, Minn., Feb. 28 (UPI) -- Often infected teeth are pulled before a patient has heart surgery to reduce the risk of infection, but U.S. researchers say this may be a catch-22.

Senior author Dr. Kendra Grim, a Mayo Clinic anesthesiologist, said problem teeth are often removed before surgery, 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 percent of patients who develop it, Grim said.

In light of that high mortality rate, physicians try to address risk factors such as poor dental health before cardiac surgery. Removing diseased teeth at some point before surgery as a preventive measure is common, but research on whether that helps has been limited.

However, the study found roughly 1-in-10 heart surgery patients who had troublesome teeth extracted before surgery died or had adverse outcomes such as a stroke or kidney failure, Grim said.

The researchers studied outcomes in 205 adult Mayo patients who had teeth pulled before cardiovascular surgery. The study covered Jan. 1, 2003, through Feb. 28, 2013; 80 percent of the patients were men, the median age at the time of tooth extraction was 62, and the median time lapse between dental extraction and heart surgery was seven days.

The findings, published in The Annals of Thoracic Surgery, included:

-- Six patients, or 3 percent, died in the period between their tooth extraction and the planned cardiac procedure.

-- Another six died after heart surgery, all while still hospitalized.

-- 10 patients, or roughly 5 percent, 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.

-- Due to unexpected complications or findings from dental surgery, at least 14 patients, or 7 percent, had to have heart surgery delayed.

More information is needed to understand why patients died or had other major adverse outcomes, the researchers said.