1 | Introduction
Cardiovascular diseases (CVDs) are the number one cause of death
globally. In 2016, CVDs representing 31 % of all global deaths .
According the 30th German national heart report published in 2018
coronary heart disease (CHD) with 7.9 % and acute myocardial infarction
with 5.3 % were the leading causes of death in Germany. The treatment
of patients with CHD is one of the most common medical tasks in
developed industrial countries.
Coronary Artery Bypass Grafting (CABG) surgery is considered proven
cardiac surgery standard procedure for patients with coronary
multivessel disease and / or main coronary stenosis. CABG survival rates
depend amongst other things on age. For instance in patients
>70 years of age, 4-year adjusted survival rate for CABG
was 95.0 %, in patients 70 to 79 years of age, survival rate was 87.3
%, and in patients ≥ 80 years of age, survival was 77.4 % . Other
independent predictors for mortality after CABG were emergency
operation, shock, preoperative renal failure, total bypass time,
intraoperative stroke, postoperative myocardial infarction,
gastrointestinal complications, respiratory failure .
Periodontitis is a chronic multifactorial host mediated inflammatory
disease associated with dysbiotic plaque biofilms and characterized by
progressive destruction of the tooth‐supporting apparatus . In a lot of
cross-sectional and longitudinal studies a significant association was
demonstrated between periodontitis and CVD [, independently of already
known risk factors.
Many studies indicate a direct, biologically plausible relationship
between periodontitis and CVD. The local host inflammatory response
induced by periodontal pathogens promotes the passage of these
microorganisms into the blood circulation . Such bacteremia and/or
endotoxemia can be caused by invasive dental treatment such as scaling
and root planing or even normal daily activities, like tooth brushing,
flossing or food intake and is furthermore associated with the severity
of periodontal disease . DNA of key bacteria for periodontitis have been
found in both in atheromas and heart tissue . In another studyAggregatibacter actinomycetemcomitans was cultured from
both, speciemens taken from periodontal pockets and atheromathous plaque
at the same patient . This finding suggests that living bacteria can get
from the oral cavity into the coronary arteries and may directly
contribute to the pathogenesis of atherosclerosis. In animal
experiments, another study showed that Porphyromonas gingivaliscan invade into heart tissue that has already been damaged by ischemia .
This result could indicate that periodontal bacteria not only play a
role in the development of atherosclerosis, but can also influence the
cardiovascular outcome after a primary event.
Periodontitis and the associated increased bacterial load can also have
an indirect proatherogenic and prothrombotic effect. Periodontitis was
found associated to increased plasma lipid concentration, increased
permeability of the coronary endothelium and increased binding of
lipoproteins in the intima . Moreover, periodontitis is associated with
an elevated general inflammatory status e.g. an increased level of
C-reactive protein (CRP) promotes several proatherogenic and
prothrombotic mechanisms such as endothelial dysfunction,
monocyte–endothelial cell adhesion, accumulation of low-density
lipoproteins (LDL) in macrophages, platelet aggregation, reactive oxygen
species production, and decrease production of nitric oxide in
endothelial cells .
Progression of CVD may be influence by successful periodontal treatment
independent of traditional risk factors . Since periodontitis is an
important factor in the pathogenesis of atherosclerosis, the aim of the
present study was to investigate whether the periodontal status is
associated with the postoperative course after CAGB surgery in patients
with CHD. If such a relation would be found periodontal diagnosis and,
if necessary, periodontal therapy early before CABG surgery may be
indicated.