Racial Disparities in the Utilization and Outcomes of Transcatheter Mitral Valve Repair: Insights From a National Database

Background: There is paucity of data on racial disparities in the utilization and outcomes of transcatheter mitral valve repair (TMVR). Methods: We queried the National inpatient Sample database (2012–2016) for TMVR hospitalizations among Caucasian and African American patients. We conducted a propensity score matching analysis to compare outcomes of Caucasians versus African Americans. The main study outcome was in-hospital mortality. Results: Among 7940 TMVR procedures performed, 680 (8.6%) were performed in African Americans. TMVR was increasingly performed for both Caucasians and African Americans (P_trend = 0.01), although the proportion of African Americans did not change significantly over time (P_trend = 0.45). Compared to African Americans, Caucasians undergoing TMVR were significantly older (77.7 ± 10.8 vs. 67.2 ± 14.28, p <. 001) and less likely to be women (45.3% vs.60.3%, p <. 001). Caucasians undergoing TMVR had a higher in-hospital mortality compared with African Americans before matching (2.5% vs. 1.5%, odds ratio [OR] 1.75; 95% confidence interval [CI] 1.17:2.63, p = .01) as well as after matching (4.7% vs. 1.6%, OR 3.10; 95% CI 1.61:5.97, p <. 001). Caucasians had higher in-hospital cardiac arrest and pacemaker insertion and shorter median length of stay. There was no difference in the incidence of other in-hospital outcomes between Caucasians and African Americans. Conclusion: This nationwide observational analysis showed a steady increase in number of TMVRs among Caucasians and African Americans. TMVR was performed in a select cohort of African Americans who were significantly younger and more likely to be women compared with Caucasians. Caucasians undergoing TMVR had higher in-hospital mortality compared with African Americans. Further research is needed to explore the reasons behind the racial disparities in the utilization and outcomes of TMVR.