Racial Disparities in Mitral Valve Surgery: A Statewide Analysis

Abstract

Objective Racial disparities in healthcare have come to the forefront. We hypothesized that black race was associated with worse preoperative risk, lower repair rates, and worse outcomes among patients undergoing mitral valve surgery.
Methods All patients who underwent mitral valve repair or replacement with or without coronary artery bypass grafting from 2011 to 2020 in a statewide collaborative database were stratified into three racial groups, White, Black, and Other. Preoperative characteristics, procedure type, and outcomes were evaluated.
Results A total of 9,074 mitral valve operations were performed at 33 centers [Black 1,009 (11.1%), White 7,862 (86.6%)]. Preoperative combined STS morbidity and mortality was significantly higher for Black patients (Black 32%, White 22%, Other 23%, [p<0.001]) due to higher proportion of diabetes, hypertension, and chronic lung disease. White patients were more likely to undergo mitral repair (White 66%, Black 53.3%, Other 57%, [p<0.001]). Operative mortality was similar across racial groups (White 3.7%, Black 4.6%, Other 4.5% [p=0.36]). After adjusting for preoperative factors, mitral etiology, and hospitals, race was not associated with mitral valve repair, complications, or mortality, but Black patients had higher odds of extended care facility utilization and readmission.
Conclusions Contrary to our hypothesis, there was no difference in the odds of repair or operative mortality across races after accounting for risk and etiology. However, Black patients are more likely to be readmitted following discharge. These findings support a greater focus on reducing disparities in mitral valve surgery.

Keywords: Race; disparities; mitral valve; mitral valve repair; postoperative complications.