Predictors and Prognostic Impact of Perioperative Hypotension During Transcatheter Aortic Valve Implantation: The Role of Diabetes Mellitus and Left Ventricular Dysfunction

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Abstract
Background: Perioperative hypotension is a frequent but underrecognized complication during transcatheter aortic valve implantation (TAVI). Although reduced left ventricular ejection fraction (EF) and low baseline blood pressure have been linked to hemodynamic instability, the role of metabolic comorbidities and procedural factors remains less well established. Methods: We retrospectively analyzed 123 patients who underwent transfemoral TAVI between June 2016 and June 2022. Perioperative hypotension was defined as a sustained systolic blood pressure < 90 mmHg or ≥30% reduction from baseline for at least 5 min. Clinical, laboratory, and procedural predictors were assessed using multivariate logistic regression, and model performance was evaluated by ROC curve analysis. Results: Perioperative hypotension occurred in 57% of patients. Independent predictors were diabetes mellitus (OR 2.79, 95% CI 1.03–7.56, p = 0.044), reduced EF (p = 0.027), lower baseline diastolic blood pressure (OR 0.935 per mmHg, 95% CI 0.893–0.978, p = 0.004), and longer procedural duration (OR 1.038 per minute, 95% CI 1.001–1.076, p = 0.044). The predictive model demonstrated good calibration and discrimination (AUC 0.844). Patients with hypotension had significantly higher in-hospital mortality (12.9% vs. 1.9%, p = 0.027) and longer ICU stay. An exploratory finding suggested less frequent use of sugammadex among hypotensive patients (11.4% vs. 32.1%, p = 0.005). Conclusions: Perioperative hypotension is common during TAVI and strongly associated with early mortality. Our study uniquely identifies diabetes mellitus as an independent predictor, alongside ventricular dysfunction, baseline blood pressure, and procedural duration. These findings suggest that careful preprocedural risk stratification, hemodynamic vigilance, and optimization of anesthetic management may improve outcomes in vulnerable patients.

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