Is antibiotic prophylaxis (use of antibiotics to prevent infection) required for dental procedures after Transcatheter Aortic Valve Replacement (TAVR)?

From the Guidelines

Antibiotic prophylaxis is recommended for dental procedures after Transcatheter Aortic Valve Replacement (TAVR) for patients with prosthetic valves, including transcatheter-implanted prostheses, as stated in the 2021 ACC/AHA guideline for the management of patients with valvular heart disease 1.

Recommendation Details

The recommended antibiotic regimen is amoxicillin 2 grams orally taken 30-60 minutes before the dental procedure. For patients allergic to penicillin, alternatives include clindamycin 600 mg, azithromycin 500 mg, or clarithromycin 500 mg, all taken orally 30-60 minutes before the procedure.

Rationale

The rationale behind this recommendation is that TAVR involves placement of a prosthetic valve, which creates a risk for infective endocarditis. Dental procedures can cause transient bacteremia, allowing oral bacteria to enter the bloodstream and potentially colonize the prosthetic valve. Antibiotic prophylaxis aims to reduce this risk by eliminating bacteria before they can establish an infection on the valve.

Key Points

• Patients who have undergone TAVR should receive antibiotics before dental procedures that involve manipulation of gingival tissue, perforation of the oral mucosa, or procedures involving the periapical region of teeth.
• The 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease also supports the use of antibiotic prophylaxis for patients with transcatheter prosthetic valves and patients with prosthetic material used for valve repair 1.
• Maintaining optimal oral health through regular professional dental care and the use of appropriate dental products is also important to reduce the risk of infective endocarditis.
• The 2020 review of guidelines for dental antibiotic prophylaxis for prevention of endocarditis and prosthetic joint infections emphasizes the importance of dental stewardship and the need for evidence-based guidelines 1.

From the Research

Antibiotic Prophylaxis for Dental Procedures after TAVR

• The need for antibiotic prophylaxis during dental procedures after Transcatheter Aortic Valve Replacement (TAVR) is a topic of interest due to the risk of infective endocarditis (IE) 2.
• A study published in the International Journal of Cardiology in 2019 found that IE prevalence after TAVR is comparable to IE following surgical prosthetic valve replacement (SVR), suggesting that similar preventive measures may be necessary 2.
• The same study recommended pre-operative dental screening for TAVR candidates, similar to those undergoing SVR, as half of the patients in both groups had findings requiring pre-procedural dental treatment 2.
• However, there is no direct evidence in the provided studies that specifically addresses the requirement of antibiotic prophylaxis for dental procedures after TAVR 3, 4, 5, 6.
• The management of patients undergoing TAVR focuses on periprocedural medication management, including antithrombotic therapy, but does not explicitly mention antibiotic prophylaxis for dental procedures 3.
• Overall, while there is an emphasis on the importance of oral health and dental screening before TAVR, the specific guidelines for antibiotic prophylaxis during dental procedures after TAVR are not clearly outlined in the provided evidence 2.