Bioprosthetic valve replacement for concomitant aortic and mitral positions

Area of Science:

• Cardiovascular Surgery
• Biomaterials Science

Background:

• Double-valve replacement (DVR) is a critical procedure for patients with severe valvular heart disease.
• Bioprosthetic valves, derived from animal tissues, offer an alternative to mechanical valves, with bovine pericardial and porcine valves being common choices.

Purpose of the Study:

• To compare the clinical outcomes of double-valve replacement (DVR) using bovine pericardial versus porcine bioprostheses.
• To evaluate differences in mortality, valve-related events, and reoperation rates between these two bioprosthetic valve types.

Main Methods:

• A nationwide cohort study utilizing the Korean National Health Insurance Service database.
• Inclusion of adult patients (≥40 years) who underwent bioprosthetic DVR between 2003 and 2018.
• Propensity score matching and competing risk analysis were employed to adjust for baseline differences and time-related outcomes.

Main Results:

• No significant differences were observed in all-cause mortality, cardiac mortality, systemic thromboembolism, or major bleeding between bovine pericardial and porcine valve groups.
• Patients receiving porcine valves demonstrated a significantly higher risk of reoperation compared to those receiving bovine pericardial valves (adjusted hazard ratio, 2.08).
• Subgroup analysis indicated that patients without diabetes and with a lower Charlson Comorbidity Index who received porcine valves had an increased risk of reoperation.

Conclusions:

• The choice between bovine pericardial and porcine bioprosthetic valves for DVR did not impact cardiovascular mortality.
• Porcine bioprosthetic valves were associated with a significantly higher risk of reoperation compared to bovine pericardial valves.