Racial Disparity Among Patients Undergoing Surgical Aortic Valve Replacement and Transcatheter Aortic Valve Replacement in the United States

Abstract

Transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive alternative to surgical aortic valve replacement (SAVR). However, racial disparities in the utilization of TAVR persist. This meta-analysis attempts to determine whether the prevalence of adverse outcomes (procedure-related complications) represent barriers to the use of TAVR among African Americans (AA). The TAVR cohort consisted of 89.6% Caucasian (C) and 4.7% AA, while the SAVR cohort included 86.9% C and 6.4% AA. The utilization rate (UR) of TAVR was 1.48 and .35 among C and AA, respectively, while the UR of SAVR was 1.44 and .48 among C and AA, respectively. Following TAVR, for AA the odds ratio (OR) was greater for stroke (OR = 1.22, P = .02) and transient ischemic attack (TIA) (OR = 1.57, P < .001) and lower for undergoing the insertion of a permanent pacemaker (OR = .81, P < .001). While there was a significant difference between C and AA in TAVR and SAVR utilization, outcomes between groups following TAVR are comparable; therefore, adverse outcomes do not appear to be a barrier to the use of TAVR among eligible AA.

Race and Ethnic Disparities in Catheter Ablation Utilization for Atrial Fibrillation: A Meta-analysis and Framework for Implementation Research

“…Of note, certain ethnic/race groups including American Indians/Native Alaskans and Native Hawaiians/other Pacific Islanders were underrepresented in the disparities literature, limiting their inclusion in the meta-analysis portion of the review. Our findings are consistent with the literature which shows disparities in the use of cardiac procedures in the United States such as diagnostic and therapeutic catheterization in ischemic heart disease, trans-aortic and surgical aortic valve replacement, and implantable cardioverter-defibrillator for primary prevention sudden cardiac death (28–30).…”