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

Persson, Michael; Edgren, Gustaf; Dalén, Magnus; Glaser, Natalie; Olsson, Martin L. LU ; Franco-Cereceda, Anders; Holzmann, Martin J. and Sartipy, Ulrik (2019) In BMJ Open 9(5).
Abstract

Objective Blood 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. Design Observational nationwide cohort study. Setting Swedish population-based study. Participants Adult 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... (More)

Objective Blood 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. Design Observational nationwide cohort study. Setting Swedish population-based study. Participants Adult 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. Exposure The patients were categorised into type A/AB and type B/O blood groups. Primary and secondary outcome measures Primary 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. Results In 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. Conclusions We 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.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
adult cardiology, cardiac epidemiology, cardiac surgery, epidemiology, valvular heart disease
in
BMJ Open
volume
9
issue
5
publisher
British Medical Journal Publishing Group
external identifiers
  • scopus:85065410671
ISSN
2044-6055
DOI
10.1136/bmjopen-2019-029109
language
English
LU publication?
yes
id
b2e6623c-4eef-4f26-b9a7-496bf91d7014
date added to LUP
2019-05-22 14:41:56
date last changed
2019-08-14 02:18:48
@article{b2e6623c-4eef-4f26-b9a7-496bf91d7014,
  abstract     = {<p>Objective Blood 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. Design Observational nationwide cohort study. Setting Swedish population-based study. Participants Adult 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. Exposure The patients were categorised into type A/AB and type B/O blood groups. Primary and secondary outcome measures Primary 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. Results In 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. Conclusions We 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.</p>},
  articleno    = {e029109},
  author       = {Persson, Michael and Edgren, Gustaf and Dalén, Magnus and Glaser, Natalie and Olsson, Martin L. and Franco-Cereceda, Anders and Holzmann, Martin J. and Sartipy, Ulrik},
  issn         = {2044-6055},
  keyword      = {adult cardiology,cardiac epidemiology,cardiac surgery,epidemiology,valvular heart disease},
  language     = {eng},
  number       = {5},
  publisher    = {British Medical Journal Publishing Group},
  series       = {BMJ Open},
  title        = {ABO blood type and risk of porcine bioprosthetic aortic valve degeneration : SWEDEHEART observational cohort study},
  url          = {http://dx.doi.org/10.1136/bmjopen-2019-029109},
  volume       = {9},
  year         = {2019},
}