Effect of Diabetes Mellitus on Clinical Outcomes After Transcatheter Aortic Valve Implantation: An Updated Systematic Review and Meta-Analysis

Abstract

Transcatheter Aortic Valve Implantation (TAVI) or Replacement (TARV) is a widely established treatment for symptomatic severe aortic stenosis (AS) in patients with high or intermediate surgical risk. Diabetes mellitus (DM) is prevalent in TAVR patients and is associated with an increased risk of cardiovascular events, which may elevate procedural risks. A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Web of Science, and Cochrane databases were searched. A random-effects model was applied, with 95% confidence intervals (CIs) and a 5% significance level. Statistical analyses were performed using RStudio version 4.4.1. Twelve studies with 214,444 patients were included, comprising 74,294 diabetic and 140,150 nondiabetic individuals. The analysis revealed no significant differences in all-cause mortality, procedure mortality, 30-day mortality, or complications such as bleeding, myocardial infarction, and major complications. However, 1-year mortality was significantly higher in the diabetic group (RR: 1.51, 95% CI: 1.08-2.13). Diabetic patients were at higher risk for renal injury (RR: 1.46, 95% CI: 1.40-1.51) and lower risk of stroke (RR: 0.91, 95% CI: 0.83-0.99). The length of hospital stay and other major complications showed no significant differences. There was an increased risk of 1-year mortality and renal injury in diabetic patients undergoing TAVI compared to non-diabetics. Surprisingly, the risk for developing stroke in the diabetic group was significantly lower. In any case, the study emphasizes the need for tighter DM control to decrease the risk of such complications in the future.

Keywords: TAVI; TAVR; complications; diabetes mellitus; meta‐analysis; mortality.