Diabetes: TAVI Trumps Heart Surgery
Patients with diabetes who had aortic stenosis fared better in terms of mortality and kidney function during the first year if they underwent transcatheter aortic valve implantation (TAVI) rather than surgery, a post-hoc analysis found.
All-cause mortality at 1 year was 18 percent among diabetic patients treated with TAVI compared with 27.4 percent of those treated surgically, for a hazard ratio of 0.60 (95% CI 0.36-0.99, P=0.04), according to Brian R. Lindman, MD, of Washington University School of Medicine in St. Louis, and colleagues.
Patients who received the transcatheter treatment also had lower rates of renal failure necessitating dialysis (4.2% versus 10.6%, P=0.05), and requiring dialysis for longer than a month (0% versus 6.1%, P=0.003), the researchers reported on Nov. 27 in the Journal of the American College of Cardiology.
The findings of this study have "important clinical implications for the treatment of patients with severe [aortic stenosis] and diabetes at high risk for surgery," Lindman and colleagues observed.
The presence of diabetes has adverse effects on morbidity and mortality in cardiovascular disease, and, in patients with aortic stenosis, can worsen left ventricular function and heart failure and can increase hypertrophic remodeling.
Diabetes has also been associated with poor outcomes after surgical aortic valve replacement. The reasons for this increased risk are not fully understood, but may involve oxidative stress, inflammation, and reperfusion injury, the researchers explained.