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July 20, 2026Cardiology Research0 citationsOpen Access

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

AAAli AwadQQQusai Al QudahJFJoud Fahed

Key Result

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

Key Points

  • Examine racial differences in procedural selection and associated outcomes for mitral valve interventions.
  • Analysis of 26,456 adults undergoing mitral valve intervention from the National Inpatient Sample (2016–2022)
  • Utilization of multivariable regression models to assess mortality, procedure type, length of stay, and charges
  • Adjustment for demographics, comorbidities, hospital characteristics, and illness severity.
  • TEER represented 89% of procedures performed; Black patients showed greater odds of receiving TEER (OR = 1.36; 95% CI, 1.15–1.61)
  • Black patients had higher mortality odds (OR = 1.49; 95% CI, 1.01–2.19; P = 0.045) compared to White patients
  • Late presentation for treatment was more common among Black (24%) and Hispanic patients (27%) compared to White patients (13%).

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
Black, Asian/Pacific Islander, or Hispanic race (assessing racial disparities as the primary exposure)
C
Comparator
White race
O
Outcome
Inpatient mortality, procedure type, length of stay, and chargeshard clinical

Significant racial disparities exist in mitral valve interventions, with Black and Asian/Pacific Islander patients experiencing higher inpatient mortality and minority groups having higher rates of late presentation.

Main Result

Odds Ratio: 1.49 (95% CI 1.01–2.19)

Absolute Event Rate: 2% vs 1.1%

p-value: p=0.045

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
  • Disparities are not fully explained by covariates available in the National Inpatient Sample (NIS)

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.

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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/6a5dba3f8bd453d3397ab729https://doi.org/10.14740/cr2226
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