Racial disparities in characteristics and outcomes of patients undergoing mitral transcatheter edge-to-edge repair

Alon Shechter; Danon Kaewkes; Moody Makar; Vivek Patel; Ofir Koren; Keita Koseki; Aum Solanki; Manvir Dhillon; Takashi Nagasaka; Sabah Skaf; Tarun Chakravarty; Raj R Makkar; Robert J Siegel

doi:10.3389/fcvm.2023.1111714

Racial disparities in characteristics and outcomes of patients undergoing mitral transcatheter edge-to-edge repair

Front Cardiovasc Med. 2023 Mar 2:10:1111714. doi: 10.3389/fcvm.2023.1111714. eCollection 2023.

Authors

Alon Shechter^{1

2

3}, Danon Kaewkes^{1

4}, Moody Makar¹, Vivek Patel¹, Ofir Koren^{1

5}, Keita Koseki^{1

6}, Aum Solanki¹, Manvir Dhillon¹, Takashi Nagasaka^{1

7}, Sabah Skaf¹, Tarun Chakravarty¹, Raj R Makkar¹, Robert J Siegel^{1

8}

Affiliations

¹ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
² Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.
³ Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
⁴ Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
⁵ Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
⁶ Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
⁷ Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
⁸ David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.

Abstract

Background: There are scarce data regarding the post-mitral transcatheter edge-to-edger repair (TEER) course in different racial groups.

Objective: To assess the impact of race on outcomes following TEER for mitral regurgitation (MR).

Methods: This is a single-center, retrospective analysis of consecutive TEER procedures performed during 2013-2020. The primary outcome was the composite of all-cause mortality or heart failure (HF) hospitalizations along the first postprocedural year. Secondary outcomes included individual components of the primary outcome, New York Heart Association (NYHA) class, MR grade, and left ventricular mass index (LVMi).

Results: Out of 964 cases, 751 (77.9%), 88 (9.1%), 68 (7.1%), and 57 (5.9%) were whites, blacks, Asians, and Hispanics, respectively. At baseline, non-whites and blacks were younger and more likely be female, based in lower socioeconomic areas, not fully insured, diagnosed with functional MR, and affected by biventricular dysfunction. Intra-procedurally, more devices were implanted in blacks. At 1-year, non-whites (vs. whites) and blacks (vs. non-blacks or whites) experienced higher cumulative incidence of the primary outcome (32.9% vs. 22.5%, p = 0.002 and 38.6% vs. 23.4% or 22.5%, p = 0.002 or p = 0.001, respectively), which were accounted for by hospitalizations in the functional MR sub-cohort (n = 494). NYHA class improved less among blacks with functional MR. MR severity and LVMi equally regressed in all groups. White race (HR 0.62, 95% CI 0.39-0.99, p = 0.047) and black race (HR 2.07, 95% CI 1.28-3.35, p = 0.003) were independently associated with the primary outcome in functional MR patients only.

Conclusion: Mitral TEER patients of different racial backgrounds exhibit major differences in baseline characteristics. Among those with functional MR, non-whites and blacks also experience a less favorable 1-year clinical outcome.

Keywords: MitraClip; mitral regurgitation; mitral transcatheter edge-to-edge repair; racial disparities; transcatheter mitral valve repair.