Surgical treatment of heart valve disease: Considerations for the dental management

Abstract

The number of valve surgeries is increasing with a change in the disease structure from rheumatic valvular heart disease (VHD) to arteriosclerotic or degenerative VHD. The treatment strategies for VHD have also been changing over the last two decades. Repair techniques for valve regurgitation have been established with excellent long‐term clinical results. As valve repair has advantages over prosthetic valve replacement in terms of avoidance of anticoagulation and reduced risk of valve infection, it has become the first choice for treatment of degenerative VHD even for infective endocarditis, which is closely related to dental procedures. With the development of technologies, minimally invasive cardiac surgery is evolving, including the introduction of video‐assisted or robotically assisted valve surgeries via minithoracotomy, or percutaneous transcatheter therapies. Notably, recently introduced transcatheter aortic valve replacement has shown excellent clinical results compared to surgical aortic valve replacement and has become a standard therapy for aortic stenosis in the elderly. Reoperative aortic valve replacement for degenerated bioprosthetic valve can also be performed using the transcatheter “Valve in Valve” technique. These minimally invasive approaches are likely to become more widely adopted and may determine the scope of therapeutic strategies for VHD into the future.

Extensive surgery in medication‐related osteonecrosis of the jaw for the prevention of infective endocarditis

“…The risk factors for vascular and valve calcification are known to include chronic kidney disease, diabetes mellitus, and aging. Treatment of VHD is often indicated by valve replacement using a prosthetic valve or valvuloplasty using a valve annulus ring 7 . MRONJ is the osteonecrosis of the jaw caused by bone‐modifying and/or antiangiogenic agents used in the treatment of osteoporosis and bone metastases of cancer 8 .…”

“…A fraction of the microorganisms, which are associated with bacteremia occurring during surgical procedures, adheres and multiplies at the site of NBTE, forming a verruca and causing IE 9 . IE is an intractable disease with a high mortality rate and a high rate of serious complications, even with modern medicine 7 . One of the causes of IE is bacteremia caused by oral surgery or oral jaw infection, including MRONJ 9 .…”

“…Treatment of VHD is often indicated by valve replacement using a prosthetic valve or valvuloplasty using a valve annulus ring. 7 MRONJ is the osteonecrosis of the jaw caused by bone-modifying and/or antiangiogenic agents used in the treatment of osteoporosis and bone metastases of cancer. 8 Because the incidence of both osteoporosis and cancer increases with age, MRONJ in the elderly is also gradually rising.…”

“…9 IE is an intractable disease with a high mortality rate and a high rate of serious complications, even with modern medicine. 7 One of the causes of IE is bacteremia caused by oral surgery or oral jaw infection, including MRONJ. 9 Therefore, IE prevention is of great interest to cardiologists, cardiovascular surgeons, and oral surgeons.…”