Chapters Transcript Video Racial and Ethnic Variations in Patients Undergoing Mitral and Tricuspid Valve Surgery Back to Symposium Hello, my name is Nolan Winnick. I'm a third year medical student and I completed this, worked with Dr James Comey at the division of cardiac surgery at the johns Hopkins Hospital. And we looked at if there was any racial or ethnic variations in preoperative characteristics and outcomes following microphone hospital valve surgery. And so we completed this research in collaboration with the Maryland cardiac surgery Quality Initiative. And so this is a collaborative statewide in Maryland That includes 10 hospitals from across the state. And we looked over a ten-year period and included just under 6000 patients that underwent mitral or track develop disease and operations in neither micro valve repair or replacement. And so what we found in preoperative characteristics is that non white patients notably black hispanic asian or mixture other race patients really presented with advanced pathology and more co morbid conditions and actually presented for more non elective surgery. And so we saw that notably for black patients, they were more likely to be female, they're more likely to have a previous valve operation more often have hypertension, diabetes or a history of stroke. And we saw that actually the median household income was a little bit lower in black patients compared to white and that they were more often on Medicaid versus white patients. And so when we actually looked at the ideology of valvular disease, the most common pathology is mitral valve disease. And within that there's different subtypes. And so we looked at the most common which is degenerative mitral valve disease. And we saw that actually white patients had a higher prevalence of mitral valve pathology with degenerative disease versus all other race or ethnicity of patients. But when we looked at rheumatic and endocarditis disease, which can sometimes be be prevented with appropriate screening, it was higher in all non white patient groups. And so actually with customers about diseases, this hasn't been readily studied, but we saw no difference in the ideology pathology. So this was a kind of direct position against the mitral valve disease. And when we looked at surgical approach, mainly for mitral valve disease with degenerative disease, we look at primarily the majority of the time we look at mitral valve repair. And so we found that in patients with degenerative mitral valve disease, the repair rates in black patients was actually 10% lower and statistically significantly lower than those in white patients that we saw across the state of Maryland, but similar to the ideology of disease, there was no difference in try customer pathology or surgical approach. And so although there was a difference in some of the operative approaches, when we accounted for all comorbidities, there was no postoperative changes in some of the major outcome metrics like morbidity, mortality, pre operatively 30 day mortality, any prolonged ventilation, any instance of renal failure, any length of stay. And so really the main summaries from our, from our study is that as cardiac surgeons or those uh and physicians in cardiac care, we need to improve this under and late referral of these non white patients or minority patients with valvular disease. And so first we can do this by measuring more of these metrics there in the outpatient setting and doing population screening. So we can now actually do this through different electronic means, like through the electronic health records. We need to increase the access to primary care for some of these patient populations and educate the primary care physicians to really recognize more specifically these mitral valve pathologies so that they these patients can get referred early um and pursue surgical interventions early at a time. So they don't come with increased comorbidities in advanced pathology. And so secondary to this, we can educate our community to recognize some of these symptoms and really the prevalence of all of these conditions of particular mitral valve pathology. And finally, as a as another metric that we can do to potentially increase these repair rates is that we saw that centers within Maryland with a very high operative um history of mitral valve disease actually perform better and had a higher repair rate. So this is potentially leading us to create Centers of Excellence for mitral valve disease in order to improve the patient care of all the patients here in Maryland Created by
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