Glycemic control after aortic valve replacement: A retrospective study

Aortic stenosis (AS) is treated through transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR), with diabetes being prevalent among these patients. Inflammation participates in the pathogenesis of AS, and emerging evidence suggests that TAVI may exert anti-inflammatory effects. Given the established link between diabetes and inflammation, we sought to evaluate the impact of aortic valve replacement (AVR) on glycemic control.

Data from 10,129 consecutive patients undergoing either TAVI or SAVR between January 2010 and January 2022 were analyzed. Of these, 3,783 with diabetes had available pre- and post-procedural glycated hemoglobin (HbA1c) measurements. Analysis of 1,284 individuals with HbA1c ≥ 7 % was conducted. Propensity-score matching produced two well-matched cohorts of 266 TAVI and SAVR patients, enabling comparison of periprocedural HbA1c.

In the total cohort (n = 1,284), HbA1c decreased from 8.15 ± 1.12 to 7.88 ± 1.38 (p < 0.001). After matching, the TAVI group showed a significant reduction from 8.31 ± 1.31 to 7.86 ± 1.56 (p < 0.001), while a modest decrease from 8.33 ± 1.33 to 8.15 ± 1.61 (p = 0.046) was observed in SAVR group. The TAVI group showed a trend toward a greater percentage change in HbA1c (p = 0.051). Clinically meaningful improvement in HbA1c (≥ 0.3 %) was similar between TAVI (53.1 %) and SAVR (45.6 %) patients (OR = 1.34, 95 % CI 0.93-1.95).

Management of AS through either intervention improved post-procedural glycemia in patients with uncontrolled diabetes. The extent of glycemic improvement was more pronounced with TAVI. Further investigations through controlled and prospective studies could provide more conclusive insights into this matter.