The impact of diabetes mellitus on outcome of patients undergoing transcatheter aortic valve replacement

Background

The outcomes of patients with diabetes mellitus (DM) who are referred to surgical aortic valve replacement are poor in comparison to non-diabetic (ND) patients. However, the outcome of diabetic patients referred to transcatheter aortic valve replacement (TAVR) is less established. Further, DM and AS are both associated with left ventricular hypertrophy. It is not clear if alleviation of AS results in greater degree of reverse remodeling in DM patients in comparison to ND. We aim to evaluate if diabetes mellitus has an impact on TAVR outcome and remodeling patterns.

Methods

All consecutive patients who underwent TAVR (2007–2012) were included in this analysis. A comparison of baseline, procedural, post-procedural outcomes and echocardiographic left-ventricle mass indices was performed between DM and ND patients.

Results

DM was prevalent in 165 of 499 (33.0%) consecutive patients who underwent TAVR. DM patients were younger, weighed more, had higher rates of renal insufficiency and larger caliber peripheral vessels. Other than that, no disparities were noted in baseline characteristics. Procedural aspects were mostly similar between the groups but ND patients had higher rates of both vascular complications and bleeding. This did not translate into statistically significant differences in mortality both at 30 days and at 1 year (DM 6.7% vs. ND 10.5%; p = 0.16 and DM 22.4% vs. 25.7%; p = 0.48, respectively). Incidences of reverse remodeling patterns were similar between the two groups.

Conclusion

TAVR outcome is probably driven by baseline characteristics and post-operative complications while diabetes itself is not associated with poor outcome after TAVR.