Management of the Dental Patient with an Implanted Left Ventricular Assist Device (LVAD), A Case Report and Suggested Guidelines for Care

Abstract

Background and Overview: Nearly 6 million Americans suffer from heart failure (HF). For patients with advanced HF refractory to medical therapy, Orthotopic Heart Transplantation (OHT) is the therapy of choice, limited primarily by donor availability. A Left Ventricular Assist Device (LVAD) can be used as a “bridge to transplant” while awaiting OHT, or as a “destination therapy”. These devices improve quality of life allowing patients to proceed with the activities of daily living independently, including presenting for routine dental care. There are few existing guidelines available for the care of these complex patients. The purpose of this study is to educate the clinician on the LVAD and to establish guidelines on the care of these patients. Case Description: A 55-year-old male suffering from HF secondary to nonischemic cardiomyopathy, a left ventricular ejection fraction of 15-20%, and severe mitral regurgitation underwent LVAD implantation as a bridge to OHT at NYU Langone Health (NYULH) in December 2017. In September of 2019 he was referred to NYU College of Dentistry for oral health clearance prior to OHT. Evaluation revealed localized chronic mild periodontitis, several teeth requiring endodontic treatment, and several non-restorable teeth requiring extraction to address potential odontogenic infections. Dental treatment was safely completed at the NYU College of Dentistry in cooperation with the patient’s LVAD coordinator for the purpose of receiving an OHT. Conclusions and Practical Implications: Dental patients with LVADs have specific needs due to their implanted cardiac device and their secondary underlying comorbidities. There are few published guidelines for the evaluation and care of the dental patient with an implanted LVAD. DHCP (dental healthcare professionals) should be aware of this cohort of patient as they may present themselves for routine or emergent care to the dental office. Management of the dental patient with an implanted VAD should be done through appropriate close interdisciplinary consultation and coordination.