Author(s)

Yunyan Qu¹, Liyu Xing², Nazanene H. Esfandiari¹, George M. Deeb², Roma Gianchandani^1*

¹Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Abor, MI, USA.
²Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Abor, MI, USA.

Objective: Trans-catheter Aortic Valve Replacement/Aortic Valve Implantation (TAVR) are increasingly performed today. We compared insulin requirements between TAVR and Surgical Aortic Valve Replacement (SAVR) patients with and without diabetes mellitus (DM) to determine optimal glucose management strategies during the perioperative period (POP). Methods: Charts of consecutive patients undergoing aortic procedures were retrospectively reviewed for glucose ranges, insulin requirements and routes of insulin administration (subcutaneous vs. intravenous) for patients with and without DM to maintain BG < 180 mg/dl and compared between the surgical and trans-catheter groups. Results: Patients with SAVRs without DM and A1C < 6.5%, needed low dose insulin infusions and could be transitioned to subcutaneous insulin by 1.5 postoperative days. Patients with SAVR and DM had higher insulin requirements and were transitioned by 2.5 postoperative days. Patients with TAVR with no known DM did not need an insulin infusion in the perioperative period. Patients with TAVR with DM and an HbA1C < 6.5% did not require insulin infusions during the procedure but only postoperatively for short periods. Patients with DM and A1C ≥ 6.5%, required higher doses of insulin infusion and transitioned to subcutaneous insulin by postoperative day 1. Conclusions: TAVR patients have different insulin requirements compared to SAVRs (p < 0.05). This information helps build a glucose management algorithm for a procedure which is increasingly performed.

Aortic Stenosis, Diabetes Mellitus, Trans-Catheter Aortic Valve Replacement, Surgical Aortic Valve Replacement, Blood Glucose Management

Qu, Y. , Xing, L. , Esfandiari, N. , Deeb, G. and Gianchandani, R. (2019) Insulin Requirements and Management in Trans-Catheter vs. Surgical Aortic Valve Replacement. Open Journal of Thoracic Surgery, 9, 17-30. doi: 10.4236/ojts.2019.93003.