Congenital Heart Disease Studies (20)Aortic Disease and Treatment Approaches (10)Cardiac Valve Diseases and Treatments (7)Cardiac and Coronary Surgery Techniques (7)Innovations in Medical Education (5)
Aykut B, Lim HK, Ngeve SM, Hoover A, Medina CK, et al.
Annals of thoracic surgery short reports •
Alpha-gal syndrome from tick bites, due to sensitivity to alpha-gal, can cause severe allergies. Heart valve implants contain alpha-gal, yet alpha-gal syndrome screening is not standard before valve replacement. This study examines perioperative outcomes in patients with alpha-gal antibodies. This is a single-institution prospective cohort study of patients undergoing bioprosthetic aortic valve replacement between January 2022 and January 2023. Anti-alpha-gal immunoglobulin E levels were measured, with primary outcomes being severe allergic reactions and in-hospital mortality, and secondary outcomes including intensive care unit and hospital stay. Of 155 patients, 32.7% (n = 19) of surgical aortic valve replacement and 29.9% (n = 29) of transcatheter aortic valve replacement patients had detectable immunoglobulin E levels without subsequent serious allergic reactions or in-hospital mortality. Postoperative hospital stay and valve function were similar across groups. In this study, sensitization to alpha-gal was not associated with serious allergic reactions and did not affect immediate aortic valve function after surgical aortic valve replacement or transcatheter aortic valve replacement.
The Journal of thoracic and cardiovascular surgery •
Galactose-α-1,3-galactose (alpha-gal) is a carbohydrate that is ubiquitously expressed in all mammals except for primates and humans. Patients can become sensitized to this antigen and develop alpha-gal syndrome (AGS), or a red meat allergy. Symptoms range from generalized gastroenteritis and malaise to anaphylaxis, and in endemic areas, the prevalence can be as high as 20%. Although AGS patients commonly avoid alpha-gal by avoiding meat, patients have also developed symptoms due to animal-derived medical products and devices. With the rise in transcatheter aortic valve replacement, we investigate the immunogenicity of common cardiac materials and valves. To assess the in vitro immunoglobulin E response toward common medical products, including cardiac patch materials and bioprosthetic valves in patients with AGS. Immunoblot and immunohistochemistry techniques were applied to assess immunoglobulin E reactivity to various mammalian derived tissues and medical products for patients with AGS. AGS serum showed strong reactivity to all of the commercially available, nonhuman products tested, including various decellularized cardiac patch materials and bioprosthetic aortic valves. AGS serum did not react to tissues prepared using alpha-gal knockout pigs. Despite commercial decellularization processes, alpha-gal continues to be present in animal-derived medical products, including bioprosthetic valves. Serum from patients with AGS demonstrates a strong affinity for these products in vitro. This may have serious potential implications for sensitized patients undergoing cardiac surgery, including early valve failure and accelerated coronary artery disease.