Alpha-Gal Syndrome and Aortic Valve Replacement

Nabeel Sami; Bharat Ravishankar; Berhane Worku; Diana Khatib; Erin McGintee; Terrence Sacchi; Ozgen Dogan; Gila Perk; Mark Reisman; Nino Mihatov

doi:10.1016/j.jaccas.2025.105478

Alpha-Gal Syndrome and Aortic Valve Replacement

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

Authors

Affiliations

¹ Division of Cardiology, Department of Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA.
² Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA; Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, USA.
³ Division of Cardiac Anesthesiology, Weill Cornell Medical College, New York, New York, USA.
⁴ ENT and Allergy Associates, Southampton, New York, USA.
⁵ Division of Cardiology, Department of Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA; Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York, USA.
⁶ Division of Cardiology, Department of Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA; Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York, USA. Electronic address: nim9139@med.cornell.edu.

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.

Publication types

Case Reports