Racial Disparities in Transcatheter Edge-to-Edge Repair Versus Open Mitral Valve Surgery: A Nationwide Analysis

Q: What are the key findings of this study?

Black patients experienced significantly higher adjusted odds of in-hospital mortality following mitral valve intervention compared to White patients (OR 1.49).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Mitral valve disease requiring intervention (n=26456). Intervention: Black race vs. White race. Primary outcome: Inpatient mortality (OR 1.49, 95% CI 1.01-2.19, p=0.045).

Q: What does this research mean for the field?

Black and Asian/Pacific Islander patients experience significantly higher adjusted odds of in-hospital mortality following mitral valve intervention compared to White patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ali Awad; Qusai Al Qudah; Joud Fahed; Mariam Chalhoub; M Chadi Alraies

doi:10.14740/cr2226

July 18, 2026Cardiology ResearchOpen Access

Racial Disparities in Transcatheter Edge-to-Edge Repair Versus Open Mitral Valve Surgery: A Nationwide Analysis

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Key result

Black race linked to ~49% higher in-hospital mortality after mitral valve intervention versus White race.

OR 1.49
95% CI 1.01-2.19
P=0.045
n=26,456

Figures

Why the study?

Racial disparities are documented across cardiovascular care, but data on mitral valve intervention remain limited.

Do racial disparities exist in procedural selection and inpatient mortality among adults undergoing mitral valve intervention?

Key Points

To examine racial differences in procedural selection, timing of presentation, and clinical outcomes among patients undergoing transcatheter edge-to-edge repair versus open mitral valve surgery.
Analyzed 26,456 hospitalizations (weighted n = 132,280) for mitral valve intervention from the National Inpatient Sample (2016–2022).
Evaluated multivariable regression models adjusting for demographics, comorbidities, hospital characteristics, and illness severity to evaluate procedural choice, in-hospital mortality, length of stay, and charges.
TEER accounted for 89% of procedures, and Black patients had higher adjusted odds of receiving TEER compared with White patients (OR = 1.36; 95% CI, 1.15–1.61; P < 0.001).
In-hospital mortality was 1.2% overall, but fully adjusted mortality remained elevated for Black patients (OR = 1.49; 95% CI, 1.01–2.19; P = 0.045) and Asian/Pacific Islander patients (OR = 2.20; 95% CI, 1.30–3.72; P = 0.003) compared with White patients.
Late presentation occurred in 24% of Black and 27% of Hispanic patients versus 13% of White patients, with adjusted odds ratios of 1.23 (95% CI, 1.08–1.41; P = 0.002) and 1.74 (95% CI, 1.47–2.06; P < 0.001), respectively.

Study Design

Type

Observational (n=26,456)

Multicenter

Yes

Structured PICO

Do racial disparities exist in procedural selection and inpatient mortality among adults undergoing mitral valve intervention?

P

Population

26,456 adults aged ≥18 years undergoing transcatheter edge-to-edge repair or open mitral valve surgery, evaluated for in-hospital outcomes.

E

Exposure

Mitral valve intervention (TEER or open surgery) in Black, Hispanic, and Asian/Pacific Islander patients

C

Comparator

Mitral valve intervention (TEER or open surgery) in White patients

O

Outcome

Inpatient mortalityhard clinical

Main Result

Odds Ratio: 1.49 (95% CI 1.01–2.19)

Absolute Event Rate: 2% vs 1.1%

p-value: p=0.045

Black and Asian/Pacific Islander patients experience significantly elevated inpatient mortality following mitral valve intervention compared to White patients, highlighting persistent racial disparities in structural heart disease outcomes.

Limitations

Administrative nature of NIS data lacks clinical detail such as echocardiographic parameters and functional status
Cannot distinguish primary from secondary mitral regurgitation
NIS does not provide hospital procedure volume directly
Race is self-reported and subject to misclassification
Only inpatient outcomes were examined; longer-term outcomes cannot be assessed
Residual confounding from unmeasured variables cannot be excluded
NIS does not contain mitral-valve-imaging data and cannot distinguish primary from secondary MR
Unmeasured differences in disease severity or anatomy not captured by administrative codes
Cannot distinguish whether residual procedure-selection disparity reflects clinical judgment, patient preferences, or systemic factors

Implication

Racial mortality disparities after mitral valve intervention merit equity-focused investigation; this cohort study leaves open causal mechanisms and intervention targets.

Abstract

Background: Racial disparities have been documented across multiple domains of cardiovascular care, yet data on mitral valve intervention remain limited. We examined racial differences in procedural selection and outcomes following transcatheter edge-to-edge repair (TEER) and open mitral valve surgery. Methods: Using the National Inpatient Sample (NIS, 2016–2022), we identified 26,456 adults undergoing mitral valve intervention. Multivariable regression models were used to assess racial differences in mortality, procedure type, length of stay, and charges, adjusting for demographics, comorbidities, hospital characteristics, and illness severity. Results: TEER comprised 89% of procedures. Black patients were younger (mean 62 vs 70 years) but presented with higher illness severity. After adjustment, Black patients had greater odds of receiving TEER (odds ratio (OR) = 1.36; 95% confidence interval (CI), 1.15–1.61). Mortality disparities persisted after adjustment: Black patients (OR = 1.49; 95% CI, 1.01–2.19; P = 0.045) and Asian/Pacific Islander patients OR = 2.20; 95% CI, 1.30–3.72; P = 0.003). Late presentation was more common among Black (24%) and Hispanic (27%) compared with White patients (13%). Conclusions: Black and Asian/Pacific Islander patients experience elevated inpatient mortality following mitral valve intervention that is not fully explained by covariates available in NIS. Late referral patterns are consistent with barriers to timely specialized care in minority populations.

Discussion

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Cite This Study

Awad et al. (2026) conducted an observational in Mitral valve disease requiring intervention (n=26,456). Black race vs. White race was evaluated on Inpatient mortality (OR 1.49, 95% CI 1.01-2.19, p=0.045). Black patients experienced significantly higher adjusted odds of in-hospital mortality following mitral valve intervention compared to White patients (OR 1.49).

synapsesocial.com/papers/6a5dba3f8bd453d3397ab729 https://doi.org/10.14740/cr2226

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Racial Disparities in Transcatheter Edge-to-Edge Repair Versus Open Mitral Valve Surgery: A Nationwide Analysis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Racial Disparities in Transcatheter Edge-to-Edge Repair Versus Open Mitral Valve Surgery: A Nationwide Analysis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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