title: Clinical impact of diabetes mellitus in patients undergoing transcatheter aortic valve replacement.
abstract: BACKGROUND
  Diabetes mellitus (DM) and aortic stenosis (AS) are frequent findings in the elderly population. Data regarding the influence of DM on the outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) due to AS are limited. The aim of this study was to examine the impact of DM on TAVR outcomes.
  
  
  METHODS
  We investigated 443 patients with severe AS undergoing TAVR. Subjects were divided into insulin-dependent diabetic mellitus (IDDM) patients (N = 44), non-dependent insulin diabetic mellitus (NIDDM) patients (N = 114) and non-diabetics (N = 285) of whom 31 (74%), 86 (79%) and 209 (76%) respectively had trans-femoral TAVR. Peri-procedural complications and outcomes were recorded according to the Valve Academic Research Consortium-2 criteria.
  
  
  RESULTS
  Patients with IDDM as well as NIDDM demonstrated similar complication rates compared with non-diabetic patients, except for acute kidney injury (AKI) grade 3 [4 (2%) and 3 (3%) vs. 1 (0.4%) respectively, p = 0.032]. Kaplan-Meier survival analysis showed that DM, regardless of the type of treatment, was not associated with increased 2 years mortality (Log-rank p value 0.44). Multivariate cox regression analysis adjusted for age, gender, coronary artery disease, DM, AKI3, hypertension, chronic renal failure and peripheral vascular disease found that AKI3 was associated with increased risk of 2 years mortality [HR = 7.35, 95% CI 2.16-25.07, p = 0.001] whereas female gender was found as a protective factor [HR = 0.47, 95% CI 0.28-0.8, p = 0.005], and DM was not associated with increased risk.
  
  
  CONCLUSIONS
  Following TAVR, DM patients seem to have similar peri-procedural and mid-term outcomes compared with patients without DM, while IDDM patients seem to suffer greater incidence of AKI. Further research in larger cohorts of patients is needed to validate our results.
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel. anatberko@gmail.com.|Department of Internal Medicine D, Chaim Sheba Medical Center, Tel Hashomer, Israel. anatberko@gmail.com.|Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. anatberko@gmail.com.
authors.forename: Anat
authors.initials: A
authors.lastname: Berkovitch
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel. Amit.Segev@sheba.health.gov.il.|Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. Amit.Segev@sheba.health.gov.il.
authors.forename: Amit
authors.initials: A
authors.lastname: Segev
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel. ibarbash@gmail.com.|Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. ibarbash@gmail.com.
authors.forename: Israel
authors.initials: I
authors.lastname: Barbash
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel. yonigros@gmail.com.|Department of Internal Medicine D, Chaim Sheba Medical Center, Tel Hashomer, Israel. yonigros@gmail.com.|Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. yonigros@gmail.com.
authors.forename: Yoni
authors.initials: Y
authors.lastname: Grossman
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel. eladmaor@gmail.com.|Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel Hashomer, Israel. eladmaor@gmail.com.|Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. eladmaor@gmail.com.
authors.forename: Elad
authors.initials: E
authors.lastname: Maor
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel. aharon.erez@gmail.com.|Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. aharon.erez@gmail.com.
authors.forename: Aharon
authors.initials: A
authors.lastname: Erez
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel. ehud_regev@012.net.il.|Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. ehud_regev@012.net.il.
authors.forename: Ehud
authors.initials: E
authors.lastname: Regev
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel. noamfink@bezeqint.net.|Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. noamfink@bezeqint.net.
authors.forename: Noam
authors.initials: N
authors.lastname: Fink
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel. ismazin@gmail.com.|Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. ismazin@gmail.com.
authors.forename: Israel
authors.initials: I
authors.lastname: Mazin
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel. hamdashraf@gmail.com.|Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. hamdashraf@gmail.com.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Hamdan
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel. Ilan.Goldenberg@sheba.health.gov.il.|Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. Ilan.Goldenberg@sheba.health.gov.il.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel. Ilan.Hay@sheba.health.gov.il.|Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. Ilan.Hay@sheba.health.gov.il.
authors.forename: Ilan
authors.initials: I
authors.lastname: Hay
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel. Danny.spiegelstein@sheba.health.gov.il.|Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. Danny.spiegelstein@sheba.health.gov.il.
authors.forename: Dan
authors.initials: D
authors.lastname: Spiegelstien
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel. Victor.Guetta@sheba.health.gov.il.|Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. Victor.Guetta@sheba.health.gov.il.
authors.forename: Victor
authors.initials: V
authors.lastname: Guetta
authors.affiliation: Leviev Heart Center, Chaim Sheba Medical Center, 52621, Tel Hashomer, Israel. Paul.Fefer@sheba.health.gov.il.|Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. Paul.Fefer@sheba.health.gov.il.
authors.forename: Paul
authors.initials: P
authors.lastname: Fefer
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology*; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D016022:Case-Control Studies; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D015994:Incidence; D007328:Insulin / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin