Impact of mandatory preoperative dental screening on infective endocarditis in patients undergoing surgical valve replacement

Abstract Background Guidelines recommend preoperative dental screening (PDS) prior to surgical valve replacement (SVR) to reduce risk of prosthetic valve infective endocarditis (IE). However, limited data support these recommendations. Purpose Investigate the effect of mandatory PDS on risk of IE in patients undergoing SVR. Methods A total of 1,207 patients undergoing SVR in Western-Denmark from 2020 to 2022 were included in this observational study. Patients were considered based on two applied PDS practices: mandatory PDS (MPDS), and no routine referral PDS (NPDS). Outcome data were retrieved from Danish registries and adjudicated using medical records. The primary endpoint was incidence of IE. Secondary endpoints were all-cause mortality, and the composite endpoint of IE and all-cause mortality. Key endpoints were also analyzed in a propensity score-matched (PSM) population. Results Of 805 patients in the MPDS, 93% (n=751) underwent subsequent PDS, compared to 5% (n=21) among 402 patients in the NPDS. Patients in the MPDS were older with higher rates of coexisting co-morbidities. During a median follow-up of 2.6 years (interquartile range 1.9-3.2 years), 3.3% (n=40) developed IE. The yearly incidence IE rate was higher in MPDS compared with NPDS (1.5% vs. 0.7%; p=0.08). All-cause mortality rate was higher in the MPDS (2-year mortality of 6.2% vs 2.3%, p=0.02) as well as the composite endpoint (p<0.01). Differences in IE rates, all-cause mortality, but not composite endpoint were abolished in 370 propensity score-matched patients. Conclusion Risk of IE was low regardless of PDS practice. MPDS prior to surgery did not alter the risk of IE or all-cause mortality in patients undergoing left-sided SVR in Denmark.Kaplan-Meier plot