Diabetes reduces survival after SAVR, but not TAVR
Patients with type 2 diabetes face an increased risk of death after surgical aortic valve replacement (SAVR), but not after transcatheter aortic valve replacement (TAVR), according to new data published in Open Heart.[1]
The study’s authors reviewed data from more than 110,000 patients who underwent aortic valve replacement to treat severe aortic stenosis (AS) from 2012 to 2017. While 54% of patients underwent TAVR, the other 46% underwent SAVR. Diabetes rates were 36.4% for the TAVR cohort and 29.1% for the SAVR cohort. All data came from the Nationwide Readmissions Database.
Overall, TAVR was linked to lower adjusted hazard ratios of both 30-day hospital readmission and mortality than SAVR. Diving deeper into the data, the rates of 30-day readmission and mortality after TAVR were not significantly different when patients presented with diabetes. After SAVR, however, the adjusted risk of 30-day mortality was higher for patients with diabetes. The risk of 30-day readmission, on the other hand, remained the same.
Researchers also noted that TAVR patients tended to be nearly a decade older than SAVR patients.
“To our knowledge, we are the first to compare the short-term outcome of aortic valve replacement in diabetes patients in SAVR and TAVR,” wrote corresponding author Charbel Abi Khalil, MD, PhD, a cardiologist with Weill Cornell Medicine-Qatar, and colleagues. “Large randomized controlled trials that compared TAVR with SAVR for severe AS in the diabetes population are lacking. The procedural choice often depends more on other factors, such as age, frailty and the presence of comorbidities, rather than diabetes alone. TAVR has been associated with better valve hemodynamics and a lower risk of structural valve deterioration over time compared with SAVR. This benefit may be particularly relevant for diabetes patients who face higher risks of vascular complications.”
Khalil et al. added that patients with diabetes are now living longer than ever, making them more and more susceptible to AS. This makes it especially important to learn as much as possible about the potential impact aortic valve replacement strategies can have on patient outcomes.
“Our data, among others, show that patients with diabetes could benefit from this minimally invasive technique without incurring additional mortality and morbidity in the short-term,” the authors wrote.
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.