Background
Diabetes mellitus (DM) is associated with adverse outcomes after surgical aortic valve replacement. However, there are conflicting data on the impact of DM on outcomes of transcatheter aortic valve replacement (TAVR).
Hypothesis
DM is associated with poor outcomes after different cardiac procedures. Therefore, DM can also be associated with poor outcomes after TAVR.
Methods
We searched PubMed and Cochrane Central Register of Controlled Trials for studies that evaluated outcomes after TAVR and stratified at least 1 of the studied endpoints by DM status. The primary endpoint was all‐cause mortality at 1 year. Secondary endpoints were early (up to 30 days) mortality, acute kidney injury (AKI), cerebrovascular accident (CVA), major bleeding, and major vascular complications. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using random effects models.
Results
We included 64 studies with a total of 38 686 patients. DM was associated with significantly higher 1‐year mortality (OR: 1.14, 95% CI: 1.04‐1.26, P = 0.008) and periprocedural AKI (OR: 1.28, 95% CI: 1.08‐1.52, P = 0.004). On the other hand, there were no significant differences between diabetics and nondiabetics in early mortality, CVAs, major bleeding, or major vascular complications.
Conclusions
DM is associated with increased 1‐year mortality and periprocedural AKI in patients undergoing TAVR. The results of this study suggest that DM is a predictor of adverse outcomes in patients undergoing TAVR.
Epidemic infectious diseases like HIV/AIDS, tuberculosis, Ebola, and more recently COVID-19, have persistent and devastating impacts in human populations across the globe. In this Review essay, we consider together the monographs Epidemic Illusions (Richardson 2021) and Fevers, Feuds, and Diamonds (Farmer 2020), as well as the documentary film Bending the Arc (Davidson and Kos 2017), Together, they demonstrate the history of transnational colonialism, the significance of structural violence as a contributor to global health inequity, and the increasing presence of co-occurring epidemics worldwide, topics which are often absent from discussions of global health systems. These three works discuss epidemics as pathologies of history and sociocultural patterns of colonial dispossession in global health systems; the inclusion of patient narratives in two of them, the film Bending the Arc and the book Fevers, Feuds, and Diamonds, is pivotal in describing the intricacies of HIV infection and other infectious diseases, as well as the complexity of gaining control of syndemic diseases. Further, these three materials point to the importance of health education in communities and of access to healthcare by community members, and to the roles that health education and access play in health policy implementation.
Background: Gender disparities in outcomes after mitral valve surgery are well known. There are only few studies reporting the influence of gender on outcomes following transcatheter edge to edge repair (TEER) of the mitral valve using MitraClip (MC). In this meta-analysis, we describe outcomes by gender after mitral valve TEER. Methods: Studies reporting gender specific outcomes in patients treated with MC were reviewed from January 2010 to February 2022. Outcomes evaluated include all-cause mortality, New York Heart Association (NYHA) class, readmission for heart failure and residual mitral regurgitation (MR) at the longest follow up. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using random effects models. Results: Seventeen studies with 33,747 patients (19,303 males and 14,444 females) were included. There was no difference in all-cause mortality (OR: 1.00, 95% CI: [0.90-1.12], p=0.93), residual MR (OR: 0.59, 95% CI: [0.34-1.02], p=0.06) or readmission for heart failure (OR: 1.04, 95% CI: [0.69-1.57], p=0.83). However, NYHA class III/IV was more frequent in female patients as compared to male patients at the end of follow up (OR: 0.62, 95% CI: [0.51-0.74], p<0.00001). Conclusions: Our meta-analysis, the largest to date, suggests that female patients have worse NHYA functional class after TEER without any difference in all-cause mortality, readmissions for heart failure or residual MR when compared to male patients.
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