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Valvular Heart Dysfunction Related To Anti-gal Antibodies
Victor H. Sainz Escarrega, MD, Benigno Ferreira Piņa, MD, Oscar S. Lomeli Sanchez, MD, MSc, Adriana Gonzalez Martinez, MD, Carlos A. Jimenez Fernandez, MD;
Instituto Cardiovascular de Minima Invasion, Zapopan, Mexico
Valvular Heart Dysfunction Related to Anti Alpha-gal Antibodies
BACKGROUND: The use of bioprosthesis for aortic valve surgery has increased in the last decade, partly due to the increased durability in newer generations of bioprosthesis and the future possibility of a TAVR in case of valvular dysfunction. Structural deterioration results in stenosis or regurgitation due to calcification, rupture, or in some cases thrombus formation. Early dysfunction with a possible immunologic origin has been previously described related to the development of Anti-gal specific antibodies.METHODS: We included 10 patients who underwent surgical valve replacement of the aortic valve with a new generation bioprosthesis through a MICS procedure. We obtained blood samples to obtain quantitative IgG and IgE Anti Alpha-gal and ran a correlation analysis with hemodynamic variables of the bioprosthesis.RESULTS: Mean follow-up of 25.48 months (5.97 - 45.87 months) at the time of the study. V max 2.6 m/s (1.86 - 3.54 m/s SD 0.50), Mean Gradient 14 mm Hg (7.2 - 26.7 mm Hg SD 5.64) and IgG Anti Alpha-gal 3.85 mgA/L (2.5 - 5.74 mgA/L SD 1.33) IgE E Anti alpha-Gal 0.021 kUA/L (0.01 - 0.04 kUA/L SD 0.19). We found a positive correlation between IgG Anti Alpha-Gal to LV EF (p = 0.03) Tau = 0.539, and a positive correlation between IgE Anti Alpha-Gal to Max Vel (p= 0.05 Tau= 0.531) and Max Gradient (p= 0.05207 con Tau= 0.5259547).CONCLUSIONS: The relationship between Alpha-Gal-specific immune reactivity and inflammation is a possible explanation for early prosthesis dysfunction. We found a positive correlation between the presence of these antibodies and hemodynamic variables related to dysfunction.LEGEND: Correlation between IgG Anti Alpha-Gal and LV Ejection Fraction and Valvular Size; and between IgE Anti Alpha-Gal and Maximum Velocity and Maximum Gradient
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