Diabetes is associated with a higher incidence of short-term mortality risk and readmission in patients who undergo surgical but not transcatheter aortic valve replacement

Department

Medicine

Document Type

Article

Publication Title

Open Heart

Abstract

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is increasingly used for aortic valve replacement instead of surgical aortic valve replacement (sAVR). We aimed to examine the impact of diabetes on 30-day mortality, 30-day readmission and compare outcomes between TAVR and sAVR.

METHODS: Data were extracted from the Nationwide Readmissions Database from 2012 to 2017. The primary outcome was 30-day mortality, and the secondary outcome was 30-day readmission.

RESULTS: The study included 110 135 patients who underwent aortic valve replacement. Of these, 59 466 (54.0%) were hospitalised for TAVR, and 50 669 (46.0%) underwent sAVR. Diabetes was present in 36.4% of TAVR patients and 29.1% of sAVR patients. In TAVR patients, the adjusted risk of 30-day readmission and mortality was similar regardless of diabetes status (aHR=0.94 (0.86-1.03); 0.97 (0.84-1.12); respectively). However, sAVR patients with diabetes had a higher adjusted risk of 30-day mortality (aHR=1.13 (1.01-1.25)) but not readmission (aHR=0.92 (0.84-1.01)). When comparing outcomes between TAVR and sAVR in patients with diabetes, TAVR patients were older and had a higher prevalence of chronic kidney disease (CKD). Nevertheless, 30-day readmission and mortality were lower in patients who underwent TAVR (aHR=0.59 (0.53-0.67), aHR=0.29 (0.25-0.34), respectively) compared with sAVR. Coronary artery disease was the most significant predictor of readmission in patients with diabetes. CKD increased the risk of mortality by almost twofold in both techniques.

CONCLUSION: Diabetes increases the risk of short-term mortality in sAVR but not TAVR. Moreover, the incidence of 30-day mortality and readmission is lower in TAVR compared with TAVR among patients with diabetes.

First Page

e003019

DOI

10.1136/openhrt-2024-003019

Volume

12

Issue

1

Publication Date

1-11-2025

Medical Subject Headings

Humans; Patient Readmission; Male; Transcatheter Aortic Valve Replacement; Female; Risk Factors; Aged; Incidence; Aged, 80 and over; Risk Assessment; Time Factors; Diabetes Mellitus; Aortic Valve Stenosis; United States; Retrospective Studies; Aortic Valve; Postoperative Complications; Treatment Outcome; Databases, Factual; Survival Rate; Heart Valve Prosthesis Implantation; Follow-Up Studies

PubMed ID

39800433

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