Bioprosthetic valve replacement for concomitant aortic and mitral positions

Objective: To compare the clinical outcomes of double-valve replacement (DVR) using bovine pericardial and porcine bioprostheses, using a nationwide administrative claims database. Methods: Adult patients (age ≥40 years) who underwent bioprosthetic DVR 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 incidences 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 considered a competing risk. Results: Among the 889 patients who met the inclusion criteria, 608 (68.3%) received a bovine pericardial valve and the other 281 (31.6%) received a porcine valve. After matching 195 pairs of patients, there were no significant differences in cardiovascular mortality, all-cause mortality, thromboembolism, or major bleeding between the bovine and porcine groups; however, patients with porcine valves had a higher risk of reoperation (adjusted hazard ratio, 2.08; 95% confidence interval, 1.10-3.94) in competing risk analyses. An adjusted subgroup analysis showed that patients without diabetes and a lower Charlson Comorbidity Index who received a porcine valve had a higher risk of reoperation. Conclusions: This nationwide cohort study on DVR revealed that the choice of bioprosthetic valve type was not associated with the risk of cardiovascular mortality. However, the use of porcine prostheses was significantly associated with a higher risk of reoperation.