植入左心室辅助装置(LVAD)的牙科患者的处理,一例报告和护理建议指南

Paul R. Baker
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引用次数: 0

摘要

背景和概述:近600万美国人患有心力衰竭(HF)。对于药物治疗难治性晚期心衰患者,原位心脏移植(OHT)是治疗的选择,主要受供体可用性的限制。在等待OHT时,左心室辅助装置(LVAD)可以作为“移植的桥梁”,也可以作为“终点治疗”。这些设备提高了生活质量,使患者能够独立进行日常生活活动,包括进行常规牙科护理。对于这些复杂病人的护理,现有的指导方针很少。本研究的目的是对临床医生进行LVAD的教育,并建立这些患者的护理指南。病例描述:2017年12月,一名55岁男性患有继发于非缺血性心肌病的HF,左心室射血分数为15-20%,并伴有严重的二尖瓣反流,在纽约大学朗格尼健康中心(NYULH)接受了LVAD植入作为OHT的桥梁。2019年9月,他在OHT之前被转介到纽约大学牙科学院进行口腔健康检查。评估显示局部慢性轻度牙周炎,几颗牙齿需要根管治疗,几颗不可修复的牙齿需要拔牙以解决潜在的牙源性感染。牙科治疗在纽约大学牙科学院与患者LVAD协调员的合作下安全完成,目的是接受OHT。结论和实际意义:由于植入心脏装置和继发性潜在合并症,lvad牙科患者有特殊的需求。对于植入左心室辅助器的牙科患者的评估和护理,很少有出版的指南。DHCP(牙科保健专业人员)应该意识到这群患者,因为他们可能会向牙科诊所提出常规或紧急护理。对植入VAD的牙科患者的管理应通过适当的密切的跨学科咨询和协调来完成。
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Management of the Dental Patient with an Implanted Left Ventricular Assist Device (LVAD), A Case Report and Suggested Guidelines for Care
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.
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