Racial Disparities in Access, Utilization, and Outcomes of Transcatheter Mitral Valve Repair in the United States: A...

Racial and ethnic disparities in cardiovascular care are well-documented; however, their impact on transcatheter mitral valve interventions, including transcatheter mitral valve repair (TMVr), remains underexplored. This review synthesizes the existing literature on racial and ethnic disparities in TMVr access, utilization, and outcomes to identify contributing factors, proposed solutions, and critical knowledge gaps. A comprehensive search of PubMed, EMBASE, and Cochrane databases from 2014 to 2024 yielded nine studies for final inclusion. Across studies, minority patients-particularly African American and Hispanic individuals-were consistently underrepresented among TMVr recipients relative to disease burden. They tended to present at younger ages, were more likely to be female, and more often underwent non-elective procedures at lower-volume centers. Minority patients experienced longer hospital stays, greater procedural costs, and higher healthcare resource utilization. While some studies reported higher post-procedural mortality or readmission rates among minorities, findings on complication rates were mixed. Contributing factors included socioeconomic stressors, Medicaid coverage, limited referrals to specialized centers, provider bias, and geographic barriers. Newer studies also highlighted disparities in TMVr access even within equal-access systems and identified income-related disparities independent of race. Proposed interventions included Medicaid expansion, coverage with evidence development, culturally competent care delivery, improved referral pathways, and community outreach. All included studies were retrospective and predominantly relied on administrative data. Prospective, longitudinal studies are needed to clarify causal drivers of disparity and inform equity-focused policies in structural heart interventions.