Type 2 Diabetes Mellitus Is Associated With Faster Degeneration of Bioprosthetic Valve

Abstract

{Background—The} present study was aimed at determining the impact of type 2 diabetes mellitus ({DM}) on postoperative bioprosthetic structural valve {degeneration.Methods} and {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.