OBJECTIVES: This study aimed to comprehensively compare the early and long-term clinical outcomes of bovine pericardial valve (BOV) and porcine valve (POV), specifically during the primary isolated aortic valve replacement (AVR), using data from the Korean National Health Insurance Service (NHIS) database. METHODS: Using the Korean NHIS claimed data, all adult patients (age ≥19) who underwent primary isolated AVR using bioprosthetic valve from 2003 to 2019 were identified and propensity-score matching (PSM) analysis was performed. RESULTS: Overall, 5470 patients with BOV (n = 3947, group B) or POV (n = 1,523, group P) were enrolled, of whom 814 pairs were matched in a 1:1 ratio using PSM analysis. Early postoperative mortality and morbidities were comparable between the groups before and after PSM, considering inter-hospital clustering. The cumulative incidence of all-cause mortality was higher in group P than in group B in the total cohort (group B 5.3%/patient-years vs group P 6.4%/patient-years, adjusted hazard ratio: 1.20, P = 0.002), whereas those differences in all-cause mortality disappeared in PSM analysis (P = 0.24). The cumulative incidences of late stroke, reoperation and infective endocarditis were not significantly different between the groups in PSM populations. CONCLUSIONS: In Korean national database cohort patients with primary isolated AVR, there was no significant difference in the early- and long-term clinical outcomes between BOV and POV.