Abstract 4370211: Racial Differences in Transcatheter Aortic Valve Replacement in a Majority-Minority Population: A Decade-Long Analysis in Hawaii

Abstract

Introduction: Native Hawaiians and Pacific Islanders (NHPI) have disproportionately high rates of heart disease. Transcatheter percutaneous aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) in pts with aortic stenosis (AS). We hypothesized that NHPI pts with severe AS would be less likely to undergo TAVR and more likely to undergo SAVR than Whites and Asians in the majority-minority population of Hawaii. Methods: We used data from The Queen’s Medical Center STS/ACC TVT and STS Adult Cardiac Surgery registries to identify all pts who underwent TAVR or isolated SAVR from 2012-23. Data were collected by trained nurse reviewers using standardized processes. We compared demographics, comorbidities, pre-op STS risk of mortality (ROM) score, procedural data and in-hospital outcomes. We used SPSS for descriptive analyses and parametric and non-parametric tests, and logistic regression to adjust for potential confounders. Our primary outcome was the proportion of patients who got TAVR vs SAVR (TAVR/SAVR). Results: Of 1732 pts who had aortic valve replacement: 489 (28.2%) had isolated SAVR and 1,243 (71.8%) TAVR. Whites, Asians, and NHPI were 38.1% (n=6600), 47.6% (n=825) and 11.3% (n=950) of all AVR. NHPI were significantly younger than Whites and Asians (67+13y vs 76+13y vs 77 +13y, p<0.001), and were more likely to have diabetes (53% vs. 29% vs. 42%, p<0.001) and prior CABG (21% vs. 15% vs. 15%, p<0.001), with a trend towards more urgent procedures (13% vs. 7% vs. 6%, p=.08). There was no significant difference in prior MI and CAD. Asians had higher ROM than Whites or NHPI. Whites were less likely to be female than Asians and NHPI. All groups were more likely to get TAVR vs. SAVR (i.e., TAVR/SAVR >1.0). However, the rates of TAVR to SAVR was significantly lower for NHPI (1.2) than Whites (3.0, p<0.001) and Asians (2.7, p<0.001) After controlling for potential confounders, NHPI (OR 0.4, 95% CI 0.3-0.7) and Asians (OR 0.5, 95% CI 0.4 to 0.7) were significantly less likely than Whites to undergo TAVR when compared to SAVR. Conclusion: Among a majority-minority population undergoing AVR, NHPI and Asians are substantially less likely to receive TAVR and more more likely to receive SAVR compared with Whites, even after controlling for potential confounders. Further research is needed to find the potential causes for our findings, including patient- and physician-related factors.