Alpha-Gal Syndrome—A Case Series of Successful Transcatheter Mammalian-Derived Aortic Valve Replacements

Alpha-gal syndrome (AGS) is an IgE-mediated hypersensitivity to galactose-α-1,3-galactose, an oligosaccharide found in mammalian tissues, including bovine or porcine-derived bioprosthetic valves and heparin. Concerns exist regarding perioperative hypersensitivity reactions in patients with AGS undergoing cardiac surgery involving xenogeneic materials. We present three patients with documented AGS who underwent transcatheter aortic valve replacement (TAVR) using bovine or porcine-derived bioprostheses. All patients underwent a preoperative evaluation by allergists, and two received no pharmacological pre-treatment. Intraoperative heparin administration was without adverse reactions in all cases. Postoperative courses were uncomplicated, with no evidence of immediate or delayed allergic responses. Follow-up periods ranged from 4 to 6 years without structural valve deterioration attributable to AGS. These cases demonstrate that patients with AGS can safely undergo TAVR with bovine or porcine-derived valves and heparin, provided they are appropriately evaluated and monitored. Despite theoretical concerns, perioperative hypersensitivity appears to be rare in this population, supporting the feasibility of xenogeneic valve use in AGS patients.