{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T20:38:33Z","timestamp":1788295113667,"version":"build-2803163510"},"reference-count":23,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Semin Cardiothorac Vasc Anesth"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>Alpha-gal syndrome (AGS) is an IgE-mediated hypersensitivity to galactose-\u03b1-1,3-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.<\/jats:p>","DOI":"10.1177\/10892532261460727","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T09:23:51Z","timestamp":1782811431000},"page":"216-220","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Alpha-Gal Syndrome\u2014A Case Series of Successful Transcatheter Mammalian-Derived Aortic Valve Replacements"],"prefix":"10.1177","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2777-8408","authenticated-orcid":false,"given":"Kian","family":"Lari","sequence":"first","affiliation":[{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahzeb","family":"Leghari","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9623-524X","authenticated-orcid":false,"given":"Alan M","family":"Smeltz","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dillon","family":"Patel","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily G","family":"Teeter","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"issue":"2","key":"e_1_3_6_2_2","first-page":"398","article-title":"Delayed anaphylaxis to red meat in patients with IgE specific for galactose \u03b1 1,3 galactose (alpha gal)","volume":"131","author":"Commins SP","year":"2013","unstructured":"Commins SP, Platts-Mills TAE. Delayed anaphylaxis to red meat in patients with IgE specific for galactose \u03b1 1,3 galactose (alpha gal). J Allergy Clin Immunol. 2013;131(2):398-405.","journal-title":"J Allergy Clin Immunol"},{"issue":"12","key":"e_1_3_6_3_2","first-page":"1935","article-title":"The geographic distribution of alpha-gal syndrome in the United States: correspondence with lone Star tick (Amblyomma americanum) populations","volume":"220","author":"Crispell G","year":"2019","unstructured":"Crispell G, Commins SP, Stephanie A, et al. The geographic distribution of alpha-gal syndrome in the United States: correspondence with lone Star tick (Amblyomma americanum) populations. J Infect Dis. 2019;220(12):1935-1941.","journal-title":"J Infect Dis"},{"key":"e_1_3_6_4_2","volume-title":"Alpha-Gal Syndrome: Surveillance Summary, United States, 2010\u20132022","author":"Centers for Disease Control and Prevention","year":"2023","unstructured":"Centers for Disease Control and Prevention. Alpha-Gal Syndrome: Surveillance Summary, United States, 2010\u20132022. CDC; 2023."},{"issue":"7","key":"e_1_3_6_5_2","first-page":"1825","article-title":"Bioprosthetic heart valves and heparin exposure in alpha-gal syndrome: implications for cardiac surgery and TAVR","volume":"37","author":"Zvara J","year":"2022","unstructured":"Zvara J, Smith AL, Mazzeffi MA, et al. Bioprosthetic heart valves and heparin exposure in alpha-gal syndrome: implications for cardiac surgery and TAVR. J Card Surg. 2022;37(7):1825-1831.","journal-title":"J Card Surg"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.10213"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2014.12.1947"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/all.13541"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2021.02.061"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2023.02.005"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaccas.2025.105478"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2020.10.029"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2016.01.010"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/0167-5699(93)90255-l"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2005.08.034"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.biomaterials.2013.06.045"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ttbdis.2021.101869"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2020.09.025"},{"key":"e_1_3_6_19_2","unstructured":"Shah SA. The overlooked cardiac implications of alpha-Gal syndrome. Cardiology magazine. American college of cardiology. 2025. https:\/\/www.acc.org\/Latest-in-Cardiology\/Articles\/2025\/07\/01\/01\/Feature-The-Overlooked-Cardiac-Implications-of-Alpha-Gal-Syndrome"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/ACI.0000000000000834"},{"key":"e_1_3_6_21_2","article-title":"Asthma & immunology. Ask the expert: heparin use in patients with suspected alpha-gal allergy","author":"American Academy of Allergy","year":"2022","unstructured":"American Academy of Allergy. Asthma & immunology. Ask the expert: heparin use in patients with suspected alpha-gal allergy. AAAAI Expert Consultation. 2022. 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