Background: Black heart transplant recipients have higher risk of mortality than White recipients. Better understanding of this disparity, including subgroups most affected and timing of the highest risk, is necessary to improve care of Black recipients. We hypothesize that this disparity may be most pronounced among young recipients, as barriers to care like socioeconomic factors may be particularly salient in a younger population and lead to higher early risk of mortality. Methods: We studied 22 997 adult heart transplant recipients using the Scientific Registry of Transplant Recipients data from January 2005 to 2017 using Cox regression models adjusted for recipient, donor, and transplant characteristics. Results: Among recipients aged 18 to 30 years, Black recipients had 2.05-fold (95% CI, 1.67–2.51) higher risk of mortality compared with non-Black recipients ( P <0.001, interaction P <0.001); however, the risk was significant only in the first year post-transplant (first year: adjusted hazard ratio, 2.30 [95% CI, 1.60–3.31], P <0.001; after first year: adjusted hazard ratio, 0.84 [95% CI, 0.54–1.29]; P =0.4). This association was attenuated among recipients aged 31 to 40 and 41 to 60 years, in whom Black recipients had 1.53-fold ([95% CI, 1.25–1.89] P <0.001) and 1.20-fold ([95% CI, 1.09–1.33] P <0.001) higher risk of mortality. Among recipients aged 61 to 80 years, no significant association was seen with Black race (adjusted hazard ratio, 1.12 [95% CI, 0.97–1.29]; P =0.1). Conclusions: Young Black recipients have a high risk of mortality in the first year after heart transplant, which has been masked in decades of research looking at disparities in aggregate. To reduce overall racial disparities, clinical research moving forward should focus on targeted interventions for young Black recipients during this period.

No abstract

No abstract

Associate Editor's Introduction-Aortic valve replacement, whether performed open or percutaneously, inherently trades the native valve disease for a new disease by virtue of the prosthetic valve. Both approaches have pitfalls and complications early, from the procedure itself (eg, heart block, perivalvular leak, ventricular injury, coronary artery ostial impingement), and later (eg, prosthetic valve endocarditis, structural valve deterioration [SVD]). With transcatheter aortic valve replacement (TAVR), even after successful deployment, the biological nature of the valve implies that SVD will eventually occur, and the risks of thrombosis and prosthetic valve endocarditis remain. With the progression of TAVR use in lower-risk cohorts, including younger patients, the long-term consequences should remain in the back of the surgeon's mind. In this invited review, the authors have provided the readership with a concise summary of issues facing surgeons involved in TAVR in both the acute and long-term periods. This summary is just that, a summary of the potential issues and some potential solutions, but it reminds us that no procedure or technique is free of complications. Knowledge and understanding of these potential complications are critical in the optimal care of our patients.