Background:In this study, we present recent trends in heart valve surgery in Korea through analyses of data from the Korea Heart Valve Surgery Registry (KHVSR). Methods: We enrolled 8,981 patients who were registered in the KHVSR from 2017 to 2020. Yearly trends in patients' baseline characteristics, surgical profiles, and early mortality rates were explored. The observed/expected mortality ratio (O/E ratio), calculated from the actual mortality in the KHVSR and the predicted mortality estimated using the EuroSCORE II, was also analyzed.
Results:The proportion of aortic valve surgery significantly increased from 56.8% in 2017 to 60.3% in 2020. The proportion of all combined procedures and minimally invasive surgery significantly increased over the 4-year study period. The operative mortality rate was 2.9% in the entire cohort, while mitral valve repair showed the lowest mortality risk (0.9%). The mortality rates of isolated aortic valve replacement (AVR) significantly decreased from 2.1% in 2017 to 0.8% in 2020 (p=0.016). Overall, the O/E ratio was 0.784 (95% confidence interval [CI], 0.677-0.902) demonstrating significantly lower actual mortality risks than expected based on the EuroSCORE II. In particular, the O/E ratios were as low as 0.364 (95% CI, 0.208-0.591) for isolated AVR.
Conclusion:The recent data from the KHVSR showed increasing trends for complex procedures and minimally invasive surgery in heart valve surgery in Korea, and demonstrated remarkably low risks of operative mortality.
OBJECTIVES
This study compared the clinical outcomes of bovine and porcine bioprosthetic valves based on structural valve deterioration(SVD) and valve haemodynamic deterioration(VHD) in the aortic position.
METHODS
From January 1995 to December 2014, patients underwent aortic valve replacement(AVR) using a bovine pericardial valve or porcine valve were enrolled. SVD and VHD were defined according to the mean transprosthetic gradient and the grade of aortic regurgitation on transthoracic echocardiography. The propensity score matching was used to adjust for differences in preoperative and operative characteristics.
RESULTS
A total of 520 patients were enrolled. 372 patients underwent AVR using a bovine pericardial valve and 148 patients underwent AVR using a porcine valve. 135 pairs of patients were extracted after propensity score matching. The median follow-up duration was 8.2 years (interquartile range, 5.4–11.3). In matched patients, there were no significant differences in overall survival (survival at 10 years: 64.7% vs 70.9%) or cardiac death (cumulative incidence at 10 years : 14.2% vs 13.1%) between two groups. The cumulative incidence of moderate or greater SVD and VHD were significantly higher in the porcine valve group than in the bovine valve group (SVD at 10 years—porcine : 29.8% vs bovine : 13%; VHD at 10 years—porcine : 19.8% vs bovine : 3.8% respectively). However, there were no significant differences in the cumulative incidence of severe SVD and severe VHD between the two groups.
CONCLUSIONS
The bovine pericardial valve should be considered in AVR because the cumulative incidences of moderate or greater SVD and VHD were significantly lower than those of porcine valve.
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