title: Comparison of Hospital Outcome of Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Diabetes Mellitus (from the Nationwide Inpatient Sample).
abstract: The comparative outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in diabetes mellitus (DM) patients are scarce. We aimed to assess and compare the outcomes of TAVR versus SAVR in DM patients using the Nationwide Inpatient Sample database from 2011 to 2013. A complete case analysis was performed for the multivariate analysis and cases with missing data were excluded. The primary end point was in-patient all-cause mortality and secondary outcomes were perioperative complications. An estimated 5,719 TAVR procedures and 65,096 SAVR procedures were performed among DM patients in the United States between 2011 and 2013. TAVR patients were older (80 ± 8.1 vs 70 ± 10, p <0.001), majority of them were women (45% vs 38%, p <0.001), and predominantly white race (total of 80%). The adjusted odds ratio (OR) for the primary outcome was significantly lower in TAVR patients (2.8% vs 3.6%, OR 0.63, p = 0.02). TAVR patients were also at lower risk for bleeding requiring transfusions (13% vs 20%, OR 0.43, p <0.01), cardiac complications (6.1% vs 14%, OR 0.34, p <0.01), respiratory complications (1.2% vs 3.7%, OR 0.26, p <0.01), postoperative sepsis (1.7% vs 3.6%, OR 0.45, p = 0.03), and acute myocardial infarction (2.5% vs 2.9%, OR 0.62, p <0.01), compared with SAVR patients. Conversely, TAVR patients were at increased risk for vascular complications (5.7% vs 3.9%, OR 1.5, p <0.01) and new pacemaker implantation (10% vs 5.7%, OR 1.5, p <0.01). The mean hospitalization cost was lower for TAVR than SAVR ($58,878 vs $63,869, p = 0.003). Length of stay (median 6 vs 8 days, p <0.001) was shorter in TAVR patients. In conclusion, TAVR may result in better in-hospital outcome than SAVR in DM patients.
authors.affiliation: Division of Cardiology, Detroit Medical Center, Detroit, Michigan. Electronic address: andotomo@hotmail.co.jp.
authors.forename: Tomo
authors.initials: T
authors.lastname: Ando
authors.affiliation: Division of Internal Medicine, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Akintoye
authors.affiliation: Division of Cardiology, Detroit Medical Center, Detroit, Michigan.
authors.forename: Tesfaye
authors.initials: T
authors.lastname: Telila
authors.affiliation: Division of Heart Failure, Mayo Clinic, Rochester, Minnesota.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Briasoulis
authors.affiliation: Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
authors.forename: Hisato
authors.initials: H
authors.lastname: Takagi
authors.affiliation: Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York; Division of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: David P
authors.initials: DP
authors.lastname: Slovut
authors.affiliation: Division of Cardiology, Detroit Medical Center, Detroit, Michigan.
authors.forename: Theodore
authors.initials: T
authors.lastname: Schreiber
authors.affiliation: Division of Cardiology, Detroit Medical Center, Detroit, Michigan.
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Grines
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Luis
authors.initials: L
authors.lastname: Afonso
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000453:epidemiology*; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000191:economics / Q000706:statistics & numerical data*; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D018805:Sepsis / Q000453:epidemiology; D065467:Transcatheter Aortic Valve Replacement / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology