Dental treatment in the cardiothoracic intensive care unit for patients with ventricular assist devices awaiting heart transplant: a case series

Objective This report aims to describe the dental protocol for treating in the intensive care unit patients with end-stage heart failure who have had ventricular assist devices (VADs) emergently implanted as a bridge to heart transplant. This protocol permitted the rendering of safe and effective dental care in this setting and did not result in near-term (1-30 days) excessive hemorrhage, local and systemic infection, or contamination of the VAD. Study Design This descriptive cross-sectional study by the University of California, Los Angeles, Hospital Dental Service examined the dental care of 9 patients (mean age, 50 ± 12.9 years) with class IV stage D heart failure. Results Nine patients, 22 days (mean) after VAD placement, received dental treatment after intravenous prophylactic antibiotics and maintenance of prior anticoagulation, antiplatelet, or antithrombin regimen. Eight patients had extractions (mean, 4; range, 1-12), and one of them also required scaling and root planing (SRP) of the remaining teeth. A ninth individual only required SRP of 4 quadrants. No adverse outcomes developed. Conclusions Emergent removal of active dental disease in patients with VAD awaiting heart transplant can be safely accomplished using established protocols with extended vigilance.