Background: The purpose of this systematic review was to determine the potential effect of dental treatment before cardiac valve surgery (CVS) or left ventricular assist device (LVAD) implantation on morbidity and mortality.

Types of studies reviewed: The authors included relevant studies from MEDLINEEmbaseand the Cochrane Central Register of Controlled Trialsincluding randomized controlled trials and cohort studiespublished from 1998 through 2019 and involving adults who received dental treatment before CVS or LVAD implantation. The authors assessed bias by using the Newcastle-Ottawa Quality Assessment Scale and evidence certainty by using the Grading of Recommendations AssessmentDevelopment and Evaluation approach. The authors used a meta-analysis with a random-effects model to estimate dichotomous and continuous outcomesexpressed as relative risk (RR) and weighted mean difference.

Results: Six studies met the inclusion criteria for CVS but none for LVAD implantation. Very low certainty in the evidence suggested uncertainty as to whether health outcomes for patients undergoing dental treatment before CVS differed from those who did not. Postsurgical outcomes included all-cause mortality (RR1.00; 95% confidence interval [CI]0.53 to 1.91)infective endocarditis (RR1.30; 95% CI0.51 to 3.35)postsurgical infection (RR1.01; 95% CI0.76 to 1.33)and length of stay in the hospital (weighted mean difference2.9; 95% CI-2.3 to 8.1).

Conclusions and practical implications: From the available evidenceit is unclear whether postoperative outcomes differ in patients receiving dental treatment before CVS compared with outcomes in those who do not. Dentists and medical care professionals should collaborate on an appropriate course of action for each patientweighing any potentially relevant care considerations.