Non-Hispanic Black patients were less likely to undergo minimally invasive mitral valve surgery (MIMVS) and had a higher risk of mortality or major complications than their non-Hispanic white counterparts, new study data report. The study also found that Hispanic individuals were about as likely as non-Hispanic white patients to undergo MIMVS, while non-Hispanic Black subjects were more likely than non-Hispanic white patients to have Medicaid insurance and be treated by low-volume surgeons, both of which are associated with lower rates of MIMVS. Laurent G. Glance, MD, of the University of Rochester School of Medicine, New York, and RAND Health, Boston, and colleagues reported these findings in a manuscript published online Wednesday in JAMA Network Open. Cardiovascular disease remains the No. 1 cause of death in the U.S. and accounts for more than a third of the mortality difference between Black and white Americans. Racial disparities in minimally invasive noncardiac surgery have been reported, but not previously in MIMVS. Therefore, the authors sought to determine whether people from racial and ethnic minorities were more likely to undergo mitral valve surgery with low-volume surgeons because high-volume surgeons are associated with better outcomes. The study analyzed patient-level data from the Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database. The authors used logistic regression to estimate the association between race and ethnicity and the use of a minimally invasive approach for isolated mitral valve repair or replacement (MVRR). They also examined the association between the composite of inpatient and 30-day mortality and major morbidity, which the STS defines as stroke, kidney failure, cardiac reoperation, deep sternal wound infection and prolonged ventilation, and race and ethnicity. The study population included 103,753 patients undergoing mitral valve surgery. Their mean age was 62 ± 13 years, nearly half (46.2% were female, most (85.8%) were non-Hispanic white individuals, with non-Hispanic Black (10%) and Hispanic (4.2%) subjects comprising the remainder. Non-Hispanic Black subjects were more likely to have Medicaid insurance (odds ratio [OR]: 2.21; 95% confidence interval [CI]: 1.64-2.98; p < 0.001) and to be treated by a low-volume surgeon (OR: 4.45; 95% CI: 4.01-4.93; p <0.001) than were non-Hispanic white individuals. Non-Hispanic Black individuals were less likely to undergo MIMVS (OR: 0.65; 95% CI: 0.58-0.73; p < 0.001) than non-Hispanic white patients, but Hispanic subjects were as likely to undergo MIMVS as their non-Hispanic white counterparts (OR 1.08; 95% CI: 0.67-1.75; p = 0.74). Patients with commercial insurance had a greater than twofold odds of undergoing MIMVS than those with Medicaid (OR: 2.35; 95% CI: 2.06-2.68; p < 0.001), while patients operated on by very-high volume surgeons (defined as 300 or more cases per year) had a more than 20-fold higher odds of undergoing MIMVS than patients operated on by low-volume surgeons (less than 20 cases per year; OR: 20.70; 95% CI: 12.7-33.9; p < 0.001). Finally, after adjusting for patient risk, non-Hispanic Black individuals were still less likely to undergo MIMVS (adjusted OR; 0.88; 95% CI: 0.78-0.99; p = 0.04) and were more likely to die or experience a major complication (adjusted OR: 1.25; 95% CI: 1.16-1.35; p < 0.001) than their non-Hispanic white counterparts. “Efforts to reduce inequity in cardiovascular medicine may need to focus on expanding insurance coverage beyond Medicaid expansion and increasing access to high-volume surgeons,” the authors concluded. The research reported in this manuscript was supported by a grant from the National Institute on Aging and the University of Rochester School of Medicine. Source: Glance LG, Joynt Maddox KE, Mazzefi M, et al. Racial and Ethnic Disparities in Access to Minimally Invasive Mitral Valve Surgery. JAMA Netw Open 2022;5:e2247968. Image Credit: Damian – stock.adobe.com