Type 2 diabetes mellitus is associated with faster degeneration of bioprosthetic valve: results from a propensity score-matched Italian multicenter study.
BACKGROUND
The present study was aimed at determining the impact of type 2 diabetes mellitus (DM) on postoperative bioprosthetic structural valve degeneration.


RESULTS
Twelve Italian centers participated in the study. Patient data refer to bioprosthetic implantations performed from November 1988 to December 2009, which resulted in 6184 patients (mean age 71.3±5.4 years, 60.1% male) being enrolled. Of these patients, 1731 (27.9%) had type 2 DM. The propensity score-matching algorithm successfully matched 1113 patients with type 2 DM with the same number of no-DM patients. The postmatching standard differences were less than 0.1 for each of the covariates, and 64.2% of DM patients were matched. The early (30 days) mortality rate was 7.8% (n=87) versus 2.9% (n=33) in patients with or without type 2 DM (P<0.001), respectively. Seven-year freedom from valve deterioration was significantly lower in patients with DM (73.2% [95% confidence interval, 61.6-85.5] versus 95.4% [95% confidence interval, 83.9-100], P<0.001). In Cox regression models with robust SEs that accounted for the clustering of matched pairs, DM was the strongest predictor of structural valve degeneration (hazard ratio 2.39 [95% confidence interval 2.28-3.52]). When we allowed for interaction between type 2 DM and other key risk factors, DM remained a significant predictor beyond any potentially associated variable.


CONCLUSIONS
Patients with type 2 DM undergoing bioprosthetic valve implantation are at high risk of early and long-term mortality, as well as of structural valve degeneration.
Cardiac Surgery Unit, Community Hospital, Piazzale Spedali Civili, Brescia, Italy. roberto_lorusso@iol.it
Roberto
R
Lorusso
Sandro
S
Gelsomino
Fabiana
F
Lucà
Giuseppe
G
De Cicco
Giuseppe
G
Billè
Rocco
R
Carella
Emmanuel
E
Villa
Emanuel
E
Villa
Gianni
G
Troise
Mario
M
Viganò
Carlo
C
Banfi
Carmine
C
Gazzaruso
Pier
P
Gagliardotto
Lorenzo
L
Menicanti
Francesco
F
Formica
Giovanni
G
Paolini
Stefano
S
Benussi
Ottavio
O
Alfieri
Matteo
M
Pastore
Sandro
S
Ferrarese
Giovanni
G
Mariscalco
Germano
G
Di Credico
Cristian
C
Leva
Claudio
C
Russo
Aldo
A
Cannata
Roberto
R
Trevisan
Ugolino
U
Livi
Roberto
R
Scrofani
Carlo
C
Antona
Andrea
A
Sala
Gian Franco
GF
Gensini
Jos
J
Maessen
Andrea
A
Giustina
D000368:Aged; D001705:Bioprosthesis / Q000706:statistics & numerical data*; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006349:Heart Valve Diseases / Q000401:mortality* / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D006801:Humans; D006943:Hyperglycemia / Q000401:mortality; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007558:Italy / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality*; D011237:Predictive Value of Tests; D011475:Prosthesis Failure / Q000009:adverse effects*; D012307:Risk Factors
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human