RACIAL AND SEX DIFFERENCES IN THE TREATMENT ALLOCATIONS AND OUTCOMES AMONG PATIENTS WITH SEVERE MITRAL VALVE DISEASE AND CHALLENGING ANATOMY

Document Type

Conference Proceeding

Publication Date

4-1-2025

Publication Title

J Am Coll Cardiol

Keywords

adult, aged, all cause mortality, Caucasian, cohort analysis, conference abstract, female, heart left ventricle outflow tract, heart left ventricle outflow tract obstruction, human, major clinical study, male, mitral valve disease, mitral valve replacement, mitral valve stenosis, sex difference, surgery

Abstract

Background: Patients with mixed mitral valve disease or mitral stenosis and small predicted neo-left ventricular outflow tract (LVOT) are difficult to treat with percutaneous therapies given risk of LVOT obstruction and often are not offered intervention. This study investigates racial and sex differences in treatment and outcomes. Methods We included 104 patients referred to the Henry Ford Hospital (Detroit, MI) between 2018 and 2024 with severe mitral stenosis (MS group) or severe mixed valve disease. These patients were mostly, high or prohibitive risk for surgery and were being considered for possible transcatheter mitral valve replacement. All these had a predicted neo-LVOT <150 mm2. Results The MS group consisted of 93 patients (89%) and the MV group of 11(11%). The cohort consisted of 92 females (88%) and 85 white patients (82%).The all-cause mortality was 30%, with cardiovascular (CV) death at 21% for the entire cohort. All-cause mortality among females was 28% vs 38% in males (p = 0.33), and CV death among females was 20% vs 33% in males (p = 0.27). The 1-year allcause mortality for females was 20% vs 38% in males (p = 0.083), and 1-year CV death was 15% for females vs 33% in males (p = 0.12). All-cause mortality among white patients was 28% vs 37% in non-whites (p = 0.46), and CV death for whites was 18% vs 37% in nonwhites (p = 0.064). The 1-year all-cause mortality was in both white and non-white patients was 21%(p = 0.99), and the 1-year CV death for whites was 15% vs 21% in non-whites (p = 0.54).Intervention rates also varied by sex and race, with 43% of females undergoing treatment compared to 67% of males. Both white (46%) and non-white (47%) patients demonstrated similar rates of undergoing. The all-cause mortality of those patients that did not undergo intervention (medical therapy only) were: females 27% vs males 25%, and white patients 23% vs non-white 40%. Conclusion This study underscores that most of the patients presenting to this tertiary heart valve center were female and mostly white. It is also notable that female patients were treated less often, and non-white patients had a higher rate of all-cause mortality when not treated percutaneously.

Volume

85

Issue

12

First Page

2256

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