Racial disparities in transcatheter aortic valve replacement: A contemporary nationwide analysis

Q: What does this research mean for the field?

Although in-hospital mortality and overall composite outcomes are comparable between White and non-White patients undergoing transcatheter aortic valve replacement (TAVR), non-White patients experience higher rates of specific complications such as acute renal failure and vascular complications, indicating persistent racial disparities. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Charley Sun; Michael Zhu; Daniel McGrath; Patrick Warner; Michael J. Dacey; Benjamin S. Wessler; Yong Zhan

doi:10.1016/j.ahjo.2026.100720

January 14, 2026American Heart Journal Plus Cardiology Research and PracticeOpen Access

Racial disparities in transcatheter aortic valve replacement: A contemporary nationwide analysis

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Why the study?

As TAVR volume increases with evolving indications, insight is needed regarding procedure access and outcomes to evaluate potential racial disparities in the contemporary era.

Does non-White race impact in-hospital mortality and procedural complications in adult patients undergoing transcatheter aortic valve replacement?

Structured PICO

Does non-White race impact in-hospital mortality and procedural complications in adult patients undergoing transcatheter aortic valve replacement?

P

Population

42,877 adults (aged ≥18 years) who underwent transcatheter aortic valve replacement (TAVR) identified in the United States National Inpatient Sample from 2016 to 2019 (37,319 White and 5,558 non-White). Mean age 79.5 (White) and 77.5 (non-White), 44.7% (White) and 50.6% (non-White) female.

I

Intervention

Transcatheter aortic valve replacement (TAVR) in non-White patients

C

Comparator

Transcatheter aortic valve replacement (TAVR) in White patients (baseline and propensity-score matched comparisons)

O

Outcome

In-hospital mortality and a composite outcome defined by occurrence of in-hospital mortality, acute renal failure (ARF), acute respiratory failure, stroke, pacemaker implantation (PPM), and vascular complicationscomposite

Limitations

Intrinsic limitations of the NIS administrative database, which relies on ICD codes primarily used for billing and is subject to error
Lack of granular insight into cohort characteristics to fully characterize patient comorbidities and history
Absence of long-term outcome data, limiting conclusions to in-hospital events
Propensity score matching models may not adequately adjust for unmeasured confounders, such as patient anatomy, device type, hospital experience, and socioeconomic status

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Implication

TAVR demonstrates equivalent safety across racial groups regarding in-hospital mortality, although non-White patients suffer disproportionately higher rates of certain post-procedural complications such as acute renal failure and vascular complications.

Abstract

Racial disparities have been reported in the management of cardiovascular diseases. Transcatheter aortic valve replacement (TAVR) volume continues to increase with evolving indications and practice changes. This study aims to provide insight regarding procedure access and outcomes to evaluate for potential racial disparities in the contemporary era of TAVR. TAVR patients (aged ≥18) were identified in the National Inpatient Sample from 2016 to 2019 and grouped by race. Baseline characteristics and in-hospital outcomes were compared between White and non-White patients before and after propensity-score matching. Primary outcomes were in-hospital mortality and a composite outcome. The individual components of the composite outcome served as secondary outcomes. Of 42,877 total TAVR patients, 37,319 were White and 5558 were non-White. Annual procedure volume in both groups increased significantly ( Ptrend < 0.001 for both). The proportions of White and non-White patients remained steady over time (12.5%–13.5% non-White, Ptrend = 0.117). The characteristics of White and non-White patients differed significantly. There was no difference in in-hospital mortality (1.5% vs 1.6%, P = 0.585) or composite outcome (23.8% vs 24.6%, P = 0.316). Non-White race was associated with higher rates of acute renal failure (odds ratio [OR]:1.21, 95% confidence interval [CI]:1.10–1.33, P < 0.001), transfusion (OR:1.18, 95%CI:1.05–1.32, P = 0.006), and vascular complications (OR:1.62, 95%CI:1.29–2.04, P < 0.001), but lower rates of permanent pacemaker implantation (OR:0.83, 95%CI:0.75–0.93, P = 0.001). TAVR remains safe in both White and non-White patients with comparable in-hospital mortality and overall outcomes. Differences in baseline characteristics and individual complications indicate the presence of racial disparities in procedure accessibility and outcomes. Meeting presentation: Presented at the Transcatheter Cardiovascular Therapeutics (TCT) 2024, October 27–30, 2024, Washington D.C.

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Cite This Study

Sun et al. (2026) studied this question.

synapsesocial.com/papers/6a100a1d9e54838161fd9a61 https://doi.org/10.1016/j.ahjo.2026.100720

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Racial disparities in transcatheter aortic valve replacement: A contemporary nationwide analysis

Figures

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Racial disparities in transcatheter aortic valve replacement: A contemporary nationwide analysis

Figures

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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