Background: Diabetes mellitus has been proved to be a potent, independent risk factor for mortality in patients with heart failure. However, the influence of diabetes on outcomes after continuous-flow left ventricular assist device (CF-LVAD) implantation is still under debate. This study sought to investigate the effect of preoperative diabetes on all-cause mortality and major postoperative complications among patients with contemporary CF-LVAD support.
Methods: A systematic literature search (PubMed, Embase, and ISI Web of Knowledge, and Cochrane Central Register of Controlled Trials) was performed. The primary endpoint was hazard ratio for all-cause mortality. Secondary endpoints were postoperative complications, including infection, transient ischemia attack, intracranial hemorrhage, and pump thrombosis. A meta-analysis was conducted to generate pooled hazard ratio and 95% confidence interval (CI) for all-cause mortality and pooled odds ratio (OR) and 95% CI for postoperative complications.
Results: A total of 1120 patients (478 diabetic patients, 642 nondiabetic patients) from four studies were included in this study. Diabetes did not increase the risk for all-cause mortality among patients with CF-LVAD support (hazard ratio 1.33; 95% CI, 0.88 to 2.02; P = .18). Moreover, pooled analysis demonstrated no significant difference was found in the diabetes and nondiabetes groups in terms of infection (OR 1.18; 95% CI, 0.89 to 1.56; P = .24), transient ischemia attack (OR 1.30; 95% CI, 0.86 to 1.97; P = .21), intracranial hemorrhage (OR 1.86; 95% CI, 0.93 to 3.71; P = .08), and pump thrombosis (OR 1.01; 95% CI, 0.68 to 1.48; P = .97).
Conclusions: The results of this meta-analysis demonstrate that diabetes does not increase all-cause mortality or rates of major adverse events during contemporary CF-LVAD support.
Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.