Related Experiment Video
Updated: Mar 4, 2026
12:17
Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
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Black Patients Experience Higher Complication Burden and Distinct Valve Selection Patterns in Aortic Valve
Joshua D Greendyk1, Julia DeLorenzo1, Jonathan R Lopez1
1Department of Medicine, Division of Cardiology, Rutgers University New Jersey Medical School, Newark, USA.
Cureus
|March 3, 2026
Summary
Black patients face disparities in aortic valve replacement (AVR) access and outcomes. While younger Black patients show higher Ross procedure use, all Black patients experience worse postoperative complications, indicating systemic inequities.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Health Equity
Background:
- The Ross procedure for aortic valve replacement (AVR) may offer better outcomes for young adults compared to traditional mechanical and bioprosthetic valves.
- Racial disparities in accessing the Ross procedure and subsequent postoperative outcomes are not well understood.
- Hypothesis: Black patients have different Ross procedure utilization due to limited valve options, with persistent disparities in complications.
Purpose of the Study:
- To evaluate racial disparities in accessing the Ross procedure for aortic valve replacement.
- To assess racial differences in postoperative outcomes following AVR, specifically comparing Black and White patients.
- To identify if Black race is an independent predictor of postoperative complications after AVR.
Main Methods:
- Analysis of open AVR cases (excluding transcatheter AVR) from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2012-2021).
- Deidentified data with Institutional Review Board (IRB) exemption.
- Univariate analysis and propensity score matching with binary logistic regression to assess the effect of Black race on access and 30-day complications, controlling for covariates like age, BMI, and comorbidities.
Main Results:
- Out of 5,698 AVR cases, Ross procedures were rare (4.6%). White patients constituted 93.7% of cases.
- Younger Black patients (<60 years) were more likely to undergo the Ross procedure than White patients, though Black patients overall received fewer mechanical AVRs.
- Black patients experienced higher rates of postoperative complications (acute renal failure, prolonged ventilation, reintubation, cardiac arrest, 30-day mortality) across all valve types. Adjusted analysis confirmed Black race as an independent predictor of severe complications.
Conclusions:
- Disparities in AVR utilization and outcomes between Black and White patients stem from structural, socioeconomic, and clinical factors, not biological differences.
- Increased Ross procedure use in younger Black patients may reflect limited valve options and higher comorbidity burden.
- Persistent worse outcomes for Black patients underscore the impact of baseline risk and systemic inequities, necessitating research into socioeconomic and care-delivery factors, alongside clinical interventions for standardized care and equity.
Keywords:
aortic stenosis (as)aortic valve replacmentracial disparityross proceduresurgical aortic valve replacement (savr)transcutaneous aortic valve replacementMore Related Videos
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