Abstract Body (Do not enter title and authors here): Aims: The aim of this systematic review with meta-analysis is to evaluate the mainly cardiovascular complications of the TAVI procedure in DM patients, addressing specifically the myocardial infarction and other injuries.

Methods: The search of this systematic review and meta-analysis was conducted in PubMed, Cochrane and Embase to verify and identify relevant original trials and observational studies, fulfilling all of the regulations established by PRISMA guideline. The inclusion criteria used were studies that approached the complications of TAVI in DM patients and studies that used major cardiovascular events and complications as the main outcome. Furthermore, the forest plots analyzed the risk ratio of myocardial infarction, stroke, renal injury and other complications in patients with and without DM, using the R software (version 4.2.3, R Foundation for Statistical Computing, Vienna, Austria) under the random-effects model to estimate pooled outcomes and heterogeneity.

Results: In outcomes related to Post-TAVI complications, a total of 5 studies were included in the bleeding outcome, involving 166,406 patients, with 60,311 in the DM group and 106,095 in the NDM group. This showed a pooled Risk Ratio of 0.98 [95% CI (0.83 to 1.17)]. Four studies were included in myocardial infarction outcome, involving 14,916 patients, with 4,536 in the DM group and 10,380 in the NDM group. The pooled Risk Ratio (RR) calculated using a random-effects model was 1.50 [95% CI (0.80 to 2.81)]. A total of 5 studies were included in renal injury outcome, involving 155,518 patients, with 56,925 in the DM group and 98,593 in the NDM group. The pooled Risk Ratio (RR) calculated using a random-effects model was 1.46 [95% CI (1.41 to 1.51)]. A total of 5 studies were included in stroke outcome, involving 166,156 patients, with 60,236 in the DM group and 105,920 in the NDM group. The pooled Risk Ratio (RR) calculated using a random-effects model was 0.91 [95% CI (0.83 to 0.99)].

Conclusion: This meta-analysis indicates that post-TAVI complications differ between diabetic and non-diabetic patients. While the risk of bleeding and stroke was comparable, diabetes was associated with a higher risk of renal injury and a potential increase in myocardial infarction. These findings emphasize the need for targeted perioperative management in diabetic patients undergoing TAVI.