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ABO blood type and risk of porcine bioprosthetic aortic valve degeneration: SWEDEHEART observational cohort study
  1. Michael Persson1,2,
  2. Gustaf Edgren3,4,
  3. Magnus Dalén1,2,
  4. Natalie Glaser1,4,
  5. Martin L Olsson5,6,
  6. Anders Franco-Cereceda1,2,
  7. Martin J Holzmann7,8,
  8. Ulrik Sartipy1,2
  1. 1 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
  2. 2 Karolinska Universitetssjukhuset, Heart and Vascular Theme, Stockholm, Sweden
  3. 3 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  4. 4 Department of Cardiology, Sodersjukhuset AB, Stockholm, Sweden
  5. 5 Department of Laboratory Medicine, Hematology and Transfusion Medicine, Lunds Universitet, Lund, Sweden
  6. 6 Department of Clinical Immunology and Transfusion Medicine, Laboratory Medicine Office of Medical Service, Region Skåne, Lund, Sweden
  7. 7 Department of Internal Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
  8. 8 Functional Area of Emergency Medicine, Huddinge, Karolinska Universitetssjukhuset, Stockholm, Sweden
  1. Correspondence to Dr Ulrik Sartipy; Ulrik.Sartipy{at}, Ulrik.Sartipy{at}


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.

Trial registration number NCT02276950

  • cardiac surgery
  • valvular heart disease
  • epidemiology
  • adult cardiology
  • cardiac epidemiology

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  • Contributors MP, GE, MD, NG, MLO, AF-C, MH and US conceived and designed the research. MP, GE, NG, MH and US acquired the data. MP and US performed statistical analyses with important contributions from GE. MP, GE, MD, NG, MLO, AF-C, MH and US contributed to the interpretation of data. MP and US drafted the manuscript. MP, GE, MD, NG, MLO, AF-C, MH and US made critical revision of the manuscript for key intellectual content and have seen and approved the final version.

  • Funding This work was supported by the Swedish Heart-Lung Foundation (grant numbers 20160522, 20160525 to US, 20090710 to GE and 20150603 to MH); the Mats Kleberg Foundation (grant number 2017-00096 to US); Karolinska Institutet Foundations and Funds (grant number 2016fobi47721 to US); Swedish Heart and Lung Association (grant number E101/16 to US); Åke Wiberg Foundation (grant number M17-0089 to US); Magnus Bergvall Foundation (grant number 2017-02054 to US); the regional ALF agreement between Stockholm County Council and Karolinska Institutet (grant number 20160329 to US); a donation from Fredrik Lundberg (to AF-C); governmental grants for clinical research to university healthcare in Lund, Sweden (grant number ALFSKANE-446521 to MLO); the Knut and Alice Wallenberg Foundation (grant number 2014.0312 to MLO); the Swedish Research Council (grant numbers 2014-71X-14251 to MLO and 2011-30405, 2007-7469 to GE); the Swedish Society for Medical Research (to GE) and the Strategic research program in Epidemiology at Karolinska Institutet (to GE).

  • Competing interests MH received consultancy honoraria from Actelion and Pfizer.

  • Ethics approval The study was approved by the regional Human Research Ethics Committee, Stockholm, Sweden (Dnr: 2017/886–32).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No data are available.

  • Patient consent for publication Not required.

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