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Case Reports
. 2025 Oct 15;30(32):105478.
doi: 10.1016/j.jaccas.2025.105478.

Alpha-Gal Syndrome and Aortic Valve Replacement

Nabeel Sami  1 , Bharat Ravishankar  1 , Berhane Worku  2 , Diana Khatib  3 , Erin McGintee  4 , Terrence Sacchi  1 , Ozgen Dogan  1 , Gila Perk  5 , Mark Reisman  5 , Nino Mihatov  6
Affiliations
Case Reports

Alpha-Gal Syndrome and Aortic Valve Replacement

Nabeel Sami et al. JACC Case Rep. .

Abstract

Background: Alpha-gal syndrome (AGS) is an IgE-mediated hypersensitivity response to galactose-alpha-1,3-galactose (alpha-gal), an oligosaccharide present in beef and pork. This complicates bioprosthetic heart valve selection, as both bovine and porcine valves contain alpha-gal, posing risks of allergic reaction and potentially accelerated structural valve degeneration.

Case summary: A 78-year-old man with AGS and severe symptomatic aortic stenosis underwent transcatheter aortic valve replacement with a porcine-derived Evolut FX 29-mm valve following multidisciplinary evaluation. Preoperative allergist-guided prophylaxis, including IgE risk stratification, antihistamines, and corticosteroids, enabled successful implantation without complications.

Discussion: Bioprosthetic valves may pose unique risks for individuals sensitized to alpha-gal, where an alpha-gal IgE to total IgE ratio ≤5% is a proposed threshold in which patients can be rechallenged with animal products. This case highlights the successful management of a slightly higher ratio.

Take-home message: The interplay between AGS, bioprosthetic valve selection, and structural valve durability necessitates an individualized approach to mitigate the hypersensitivity risks.

Keywords: Doppler ultrasound; aortic valve; cardiac risk; echocardiography; stenosis; valve replacement.

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Conflict of interest statement

Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Transthoracic Echocardiogram With Spectral Doppler (A) Spectral Doppler echocardiography demonstrating severe aortic stenosis. Red arrows show a mean pressure gradient of 41.1 mm Hg, peak aortic velocity of 4 m/s, and aortic valve area of 0.989 cm2. (B) Parasternal short-axis view showing an incompletely closed aortic valve during diastole with thickened cusps from moderate valve calcification.
Figure 2
Figure 2
Left Coronary Angiography Evolut Fx 29-mm Porcine Valve in the Aortic Position During Left Coronary Angiography
Visual Summary
Visual Summary
Brief Timeline of Clinical Events and Interventions
See this image and copyright information in PMC

References

    1. Otto C.M., Nishimura R.A., Bonow R.O., et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease. J Am Coll Cardiol. 2021;77(4):e25–e197. doi: 10.1016/j.jacc.2020.11.018. - DOI - PubMed
    1. Mack M.J., Leon M.B., Thourani V.H., et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380(18):1695–1705. doi: 10.1056/NEJMoa1814052. - DOI - PubMed
    1. Popma J.J., Deeb G.M., Yakubov S.J., et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med. 2019;380(18):1706–1715. doi: 10.1056/NEJMoa1816885. - DOI - PubMed
    1. Kuravi K.V., Sorrells L.T., Nellis J.R., et al. Allergic response to medical products in patients with alpha-gal syndrome. J Thorac Cardiovasc Surg. 2022;164(6):e411–e424. doi: 10.1016/j.jtcvs.2021.03.100. - DOI - PMC - PubMed
    1. Hawkins R.B., Frischtak H.L., Kron I.L., Ghanta R.K. Premature bioprosthetic aortic valve degeneration associated with allergy to galactose-alpha-1,3-galactose. J Card Surg. 2016;31(7):446–448. doi: 10.1111/jocs.12764. - DOI - PMC - PubMed

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