Sex and Racial Disparities in Outcomes of Transcatheter Edge-to-Edge Mitral Valve Repair for Functional Mitral Regurgitation: A Multicenter Prospective Analysis.
BACKGROUND: Functional mitral regurgitation (FMR) is associated with poor heart failure (HF) outcomes. Mitral transcatheter edge-to-edge repair (M-TEER) is recommended for symptomatic patients despite medical therapy, though the influence of sex and race on outcomes remains understudied. METHODS: We analyzed Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapeutics registry data on patients undergoing M-TEER for FMR (November 2013 to December 2021). Primary outcomes were 30-day and 12-month all-cause and HF hospitalizations and mortality. Cox models adjusted for demographic and clinical variables. RESULTS: A total of 9441 patients were enrolled (57.4% male; 80.4% White, 16.3% Black, 2.7% Asian). Black patients were younger, had lower left ventricular (LV) ejection fraction, and had larger LV dimensions compared to White patients. They experienced lower 30-day procedural success rates (48.9% vs. 57.0%; p < 0.001) and higher adjusted 12-month HF hospitalizations (adjusted hazard ratio 1.35; 95% CI 1.09-1.67; p = 0.006). Asian patients generally demonstrated outcomes comparable to White patients. Female patients had higher baseline LV ejection fraction and smaller ventricular dimensions but demonstrated lower 30-day procedural success (48.1% vs. 61.3%; p < 0.001) and higher unadjusted 30-day readmission rates. However, adjusted 1-year outcomes were like males. CONCLUSIONS: Racial and sex disparities in M-TEER outcomes are evident. Black patients present with more advanced disease and experience lower procedural success and higher 12-month HF readmission rates compared to White. Female patients demonstrate lower procedural success but similar long-term adjusted outcomes compared to males. Efforts to address these disparities are essential to improving outcomes for all FMR patients.
