Kim Hong Rae, Oh Ha Eun, Kim Ho Jin, Kim Seon-Ok, Kim Ye-Jee, Ahn Jung-Min, Kim Joon Bum, Kim Dae-Hee
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
JTCVS Open. 2025 Apr 23;26:61-74. doi: 10.1016/j.xjon.2025.04.013. eCollection 2025 Aug.
To compare the clinical outcomes of double-valve replacement (DVR) using bovine pericardial and porcine bioprostheses, using a nationwide administrative claims database.
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.
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.
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.
利用全国行政索赔数据库比较使用牛心包生物瓣膜和猪生物瓣膜进行双瓣膜置换术（DVR）的临床结果。
从韩国国民健康保险服务数据库中识别出2003年至2018年间接受生物瓣膜DVR的成年患者（年龄≥40岁）。关注的结果包括全因死亡率、心脏死亡率和瓣膜相关事件，包括再次手术、心内膜炎、系统性血栓栓塞和大出血的发生率。使用倾向评分匹配进行基线调整。使用竞争风险分析评估与时间相关的结果，将死亡视为竞争风险。
在符合纳入标准的889例患者中，608例（68.3%）接受了牛心包瓣膜，其余281例（31.6%）接受了猪瓣膜。在匹配195对患者后，牛心包瓣膜组和猪瓣膜组在心血管死亡率、全因死亡率、血栓栓塞或大出血方面无显著差异；然而，在竞争风险分析中，接受猪瓣膜的患者再次手术风险更高（调整后的风险比为2.08；95%置信区间为1.10 - 3.94）。调整后的亚组分析显示，未患糖尿病且Charlson合并症指数较低的患者接受猪瓣膜后再次手术风险更高。
这项关于DVR的全国队列研究表明，生物瓣膜类型的选择与心血管死亡风险无关。然而，使用猪生物瓣膜与再次手术风险显著升高相关。
