Relationship between race and mortality and morbidity after valve replacement surgery

Area of Science:

• Cardiovascular Surgery
• Health Services Research
• Racial Disparities in Healthcare

Background:

• Previous research indicated black race as a predictor of increased operative mortality after coronary artery bypass surgery.
• Higher incidence of hypertension and left ventricular hypertrophy in Black individuals suggests potential increased risk after aortic valve replacement (AVR) or mitral valve replacement (MVR).

Purpose of the Study:

• To evaluate the association between race and operative mortality and morbidity after isolated AVR or MVR using a multivariable model.
• To investigate if race is an independent predictor of adverse outcomes following AVR or MVR.

Main Methods:

• Retrospective review of the Society of Thoracic Surgeons National Cardiac Database (1999-2002).
• Analysis included 3137 Black and 46,249 White patients undergoing isolated AVR or MVR.
• Multivariate logistic regression adjusted for covariates to assess the association between race and mortality/morbidity.

Main Results:

• Black race was not a significant predictor of operative mortality after isolated AVR or MVR.
• Black race was associated with increased risk of prolonged ventilation, extended postoperative stay (>14 days), reoperation for bleeding (AVR), and postoperative renal failure (MVR).
• No significant association was found between race and the risk of stroke or deep sternal wound infection.

Conclusions:

• Race is not a significant predictor of operative mortality after isolated AVR or MVR, contrary to findings in coronary artery bypass surgery.
• An association exists between Black race and specific postoperative complications following AVR or MVR.
• Further research may be needed to understand and mitigate these identified racial disparities in complications.