Bovine pericardial versus porcine bioprosthetic aortic valves: A nationwide population-based cohort study in Korea

Hong Rae Kim; Ho Jin Kim; Seonok Kim; Yejee Kim; Jung-Min Ahn; Joon Bum Kim; Dae-Hee Kim

doi:10.1016/j.jtcvs.2023.10.060

Bovine pericardial versus porcine bioprosthetic aortic valves: A nationwide population-based cohort study in Korea

J Thorac Cardiovasc Surg. 2023 Nov 4:S0022-5223(23)01017-6. doi: 10.1016/j.jtcvs.2023.10.060. Online ahead of print.

Authors

Hong Rae Kim¹, Ho Jin Kim¹, Seonok Kim², Yejee Kim², Jung-Min Ahn³, Joon Bum Kim⁴, Dae-Hee Kim⁵

Affiliations

¹ Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
² Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
³ Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
⁴ Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: jbkim1975@amc.seoul.kr.
⁵ Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: daehee74@amc.seoul.kr.

PMID: 37931797
DOI: 10.1016/j.jtcvs.2023.10.060

Abstract

Objective: To compare the clinical outcomes of aortic valve replacement (AVR) using bovine pericardial and porcine bioprostheses, utilizing a nationwide administrative claims database.

Methods: Adult patients (age ≥40 years) who underwent bioprosthetic AVR, without other valve replacements, between 2003 and 2018 were identified from the Korean National Health Insurance Service database. The outcomes of interest were all-cause mortality, cardiac mortality, and valve-related events, including the incidence of reoperation, endocarditis, systemic thromboembolism, and major bleeding. Baseline adjustment was performed using propensity score matching. Time-related outcomes were evaluated using a competing risk analysis, with death as a competing risk.

Results: Among the 7714 patients who underwent bioprosthetic AVR, 5621 (72.9%) received bovine pericardial prostheses and 2093 (27.1%) received porcine bioprostheses. After matching, 1937 pairs were included in the final analysis. During follow-up (median, 4.49 years; interquartile range, 2.83-8.20 years), the use of porcine bioprostheses was associated with a higher risk of aortic valve reoperation (adjusted hazard ratio [HR], 1.87; 95% confidence interval [CI], 1.16 to 3.01); however, no significant differences were observed in cumulative incidences of all-cause mortality, cardiac mortality, thromboembolism, or major bleeding. Subgroup analyses revealed that the use of bovine valves was associated with improved survival in patients with diabetes mellitus, whereas in patients undergoing dialysis, porcine valves exhibited better survival than bovine valves.

Conclusions: In this large nationwide cohort study of patients undergoing bioprosthetic aortic valve replacement, the use of porcine prostheses was significantly associated with an increased risk of reoperation compared with the use of bovine prostheses, supporting previous findings.

Keywords: aortic stenosis; aortic valve replacement; heart valve prosthesis.