Zahnsanierung vor Herzklappenersatz – ein CME-Artikel der S2k-Leitlinie

Die Zahnsanierung vor Herzklappenersatz ist essenziell, um das Risiko einer infektiösen Endokarditis zu bannen. Der Beitrag benennt Relevanz und Indikationen, damit die Behandler die leitliniengerechte Therapie eines sanierungsbedürftigen Befunds korrekt durchführen können. Hierdurch soll die Versorgungsqualität betroffener Patienten durch Elimination von Komplikationen aus einer unzureichenden oder zu aggressiven Sanierung vor Herzklappenersatz verbessert werden.

Kernaussagen

• Die beteiligten Ärzte sollten das individuelle Risiko der Zahnsanierung für systemisch bedrohliche Zwischenfälle in der Patientengruppe vor Herzklappenersatz möglichst genau einschätzen können.

• Medizinische Gesichtspunkte sind der Erhaltung von Zähnen in ihrer Funktion i. d. R. übergeordnet.

• Patienten vor Herzklappenersatz sollten ihre Mundhygiene optimieren.

• Die Zahnsanierung vor Herzklappenersatz soll bei minimaler Belastung des Patienten eine behandlungsfreie Phase von mindestens 6 Monaten ermöglichen, da in dieser Zeit das höchste Risiko für eine schwere oder letale infektiöse Endokarditis besteht.

• Strikt radikale Sanierungsmaßnahmen sind abzulehnen, da in bis zu 80% der Fälle vor dem Auftreten der IE keine auszulösende Ursache festzustellt werden kann.

• Die Verbesserung der oralen Plaquekontrolle durch Scaling kann vermutlich das IE-Risiko senken.

• Die chirurgische Zahnsanierung selbst kann nach den aktuellen Untersuchungen bei Ressourcenknappheit ohne negative Folgen für das kardiale Behandlungsergebnis zeitgleich mit der Herzklappenoperation durchgeführt werden.

Schlüsselwörter

Zahnsanierung - Herzklappenersatz - infektiöse Endokarditis - Nachsorge - Prophylaxe

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