Investigating the results of transcatheter aortic valve implantation (TAVI) in non-diabetic and diabetic patients: a systematic review and meta-analysis.

Abstract

Background: Transcatheter aortic valve implantation (TAVI) has emerged as an effective treatment option for patients with severe aortic stenosis, particularly in those who are not suitable candidates for open-heart surgery. While diabetes is known to be associated with a higher risk of cardiovascular diseases, the impact of diabetes on the outcomes of TAVI remains controversial.

Methods: A systematic literature search was conducted across major databases, including PubMed, Web of Science (WOS), and Google Scholar, for studies published in English over the past 20 years, up until July 2024.

Results: A total of 10 observational studies were analyzed, revealing that diabetic patients were generally younger than non-diabetic patients. The 30-day mortality rate was lower in non-diabetics (0.03 [0.02-0.04]) compared to diabetics (0.04 [0.03-0.05]). However, the hazard ratio for death beyond 30 days in diabetics was 2.05 (95% CI: 0.91-4.60, p = 0.08), and at one year, it was 1.04 (95% CI: 0.78-1.39, p = 0.77), with neither result reaching statistical significance. Meta-regression analysis showed that non-insulin-treated diabetes was significantly associated with an increased risk of acute kidney injury (AKI) compared to non-diabetics, with a log odds ratio (LogOR) of 0.3393 (p = 0.035) in one analysis and 0.3166 (p = 0.028) in another, confirming a statistically significant increase in AKI risk.

Conclusions: This review highlights that while diabetes slightly increases short-term mortality after TAVI, long-term survival remains comparable to non-diabetic patients. However, non-insulin-treated diabetes significantly raises the risk of acute kidney injury (AKI), emphasizing the need for enhanced renal protection and perioperative management.

Clinical trial number: Not applicable.