ABO blood type and risk of porcine bioprosthetic aortic valve degeneration: SWEDEHEART observational cohort study

Abstract

ObjectiveBlood type A antigen on porcine aortic bioprostheses might initiate an immune reaction leading to an increased frequency of structural valve deterioration in patients with blood type B or O. The aim was to analyse the association between ABO blood type and porcine bioprosthetic aortic valve degeneration.DesignObservational nationwide cohort study.SettingSwedish population-based study.ParticipantsAdult patients (n=3417) who underwent surgical aortic valve replacement and received porcine bioprosthetic aortic valves between 1995 and 2012 from the Swedish Web system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies register. The study database was enriched with information from other national registers.ExposureThe patients were categorised into type A/AB and type B/O blood groups.Primary and secondary outcome measuresPrimary outcome measure was aortic valve reoperation, and secondary outcomes were heart failure and all-cause mortality. We report risk estimates that account for the competing risk of death.ResultsIn total, 3417 patients were identified: 1724 (50.5%) with blood type A/AB and 1693 (49.5%) with blood type B/O. Both groups had similar baseline characteristics. The cumulative incidence of aortic valve reoperation was 3.4% (95% CI 2.5% to 4.4%) and 3.6% (95% CI 2.6% to 4.6%) in the type B/O and the A/AB group, respectively, at 15 years of follow-up (absolute risk difference: −0.2% (95% CI −1.5% to 1.2%)). There was no significantly increased risk for aortic valve reoperation in patients with blood type B/O compared with type A/AB (HR 0.95, 95% CI 0.62 to 1.45). There was no significant difference in absolute or relative risk of heart failure or death between the groups.ConclusionsWe found no significant association between patient blood type and clinical manifestations of structural valve deterioration following porcine aortic valve replacement. Our findings suggest that it is safe to use porcine bioprosthetic valves without consideration of ABO blood type in the recipient.Trial registration numberNCT02276950

Comparison of Long-term Performance of Bioprosthetic Aortic Valves in Sweden From 2003 to 2018

“…[2][3][4] Different xenograft materials have been used, such as porcine or bovine pericardium or valve tissue. 5,6 Efforts to optimize the hemodynamic performance of bioprosthetic valves have included the supra-annular approach, external wrapping of leaflets around stents, and stentless designs. [7][8][9][10] In attempts to improve the longevity of valves, different methods of tissue preservation and anticalcification treatments were developed.…”

“…Since bioprosthetic aortic valve replacement was first described in the 1960s, a wide range of different bioprosthetic models have been developed to improve patient outcomes . Different xenograft materials have been used, such as porcine or bovine pericardium or valve tissue . Efforts to optimize the hemodynamic performance of bioprosthetic valves have included the supra-annular approach, external wrapping of leaflets around stents, and stentless designs .…”

An agnostic study of associations between ABO and RhD blood group and phenome-wide disease risk

“…Using the Scandinavian Donation and Transfusion (SCANDAT) database, we have previously studied associations between ABO blood groups and cancer subtypes, cardiovascular and thromboembolic disease, the occurrence of dementia and degradation of bioprosthetic aortic valves in relation to ABO blood group ( Vasan et al, 2016a ; Persson et al, 2019 ; Vasan et al, 2016b ; Vasan et al, 2015 ). However, these and most other prior studies into the association between ABO blood group and disease outcomes have been limited by potentially misdirected a priori hypotheses and phenome-wide disease associations have not been thoroughly explored in a systematic manner.…”

An agnostic study of associations between ABO and RhD blood group and phenome-wide disease risk

“…Using the Scandinavian Donation and Transfusion (SCANDAT) database, we have previously studied associations between ABO blood groups and cancer subtypes, cardiovascular and thromboembolic disease, the occurrence of dementia and degradation of bioprosthetic aortic valves in relation to ABO blood group (6,(16)(17)(18). However, these and most other prior studies into the association between ABO blood group and disease outcomes have been limited by potentially misdirected a priori hypotheses and phenome-wide 4 disease associations have not been thoroughly explored in a systematic manner.…”