Shaare Zedek Trans Catheter Aortic Valve Implantation(TAVI) Program: Ethnic Differences

Introduction: The Arab minority in Israel occupies the lowest strata of the socioeconomic hierarchy. Despite the improvement in various health indicators, life expectancy remains higher among Jews than Arabs. Little is known about ethnic disparities in the field of transcatheter aortic valve implantation (TAVI).

Material & Methods: All consecutive TAVI patients who underwent the procedure at Shaare Zedek medical center (SZMC) were included. Patients were retrospectively analyzed for baseline clinical and echocardiographic characteristics as well as outcomes.

Results & Discussion: 976 patients underwent TAVI between 2008-2021in SZMC. Of them, 92 patients (9.4%) were Arabs. Arabs were significantly younger (mean age 77.6±8.5 versus 81.5±7.6 years; p<0.0001) compared to Jewish patients. Arabs had more Diabetes (55.7% versus 36.2%; p<0.0001), hyperlipidemia (71.6% vs 58.2%; p=0.015), smoking rates (30.7% vs 15.3%; p<0.0001), chronic renal disease (44.3% versus 27.8%; p<0.001), heart Failure (51.1% versus 32.3%; p<0.0001) including higher rate of reduced ventricular function (EF < 40%) (18.7% vs 8.5%; p=0.002) and atrial fibrillation (39.8% versus 29.2%; p=0.039) as compared to Jews. No differences were observed in the history of IHD between the two populations. Arab patients remained on follow up significantly less compared to Jewish patients with a median time of 250 days (25-889) versus 548 days (127-1255) respectively (p=0.001). Nevertheless, mortality rates during follow up were similar (33.7% among Arab versus 27.5% in Jewish patients; p=0.207).

Conclusions: Arab Patients in our TAVI program were significantly younger than Jewish patients. Arabs, despite being on average 4 years younger, had similar mortality rates to Jews porbably owing to more prevalent comorbidties among their Population.