Deparments of Cardiovascular Surgery and Cardiovascular Research Laboratory Geneva University Hospitals and Faculty of Medicine Geneva Switzerland.
Service de Chirurgie Thoracique Hôpitaux Universitaire de StrasbourgParis University Paris France.
J Am Heart Assoc. 2020 Aug 4;9(15):e015909. doi: 10.1161/JAHA.119.015909. Epub 2020 Jul 23.
Background Pigs/bovines share common antigens with humans: α-Gal, present in all pigs/bovines close to the human B-antigen; and AH-histo-blood-group antigen, identical to human AH-antigen and present only in some animals. We investigate the possible impact of patients' ABO blood group on bioprosthesis structural valve degeneration (SVD) through calcification/pannus/tears/perforations for patients ≤60 years at implantation. Methods and Results This was a single-center study (Paris, France) that included all degenerative bioprostheses explanted between 1985 and 1998, mostly porcine bioprostheses (Carpentier-Edwards second/third porcine bioprostheses) and some bovine bioprostheses. For the period 1998 to 2014, only porcine bioprostheses with longevity ≥13 years were included (total follow-up ≥29 years). Except for blood groups, important predictive factors for SVD were prospectively collected (age at implantation/longevity/number/site/sex/SVD types) and analyzed using logistic regression. All variables were available for 500 explanted porcine bioprostheses. By multivariate analyses, the A group was associated with an increased risk of: tears (odds ratio[OR], 1.61; =0.026); pannus (OR, 1.5; =0.054), pannus with tears (OR, 1.73; =0.037), and tendency for lower risk of: calcifications (OR, 0.63; =0.087) or isolated calcification (OR, 0.67; =0.17). A-antigen was associated with lower risk of perforations (OR 0.56; =0.087). B-group patients had an increased risk of: perforations (OR, 1.73; =0.043); having a pannus that was calcified (OR, 3.0, =0.025). B-antigen was associated with a propensity for calcifications in general (OR, 1.34; =0.25). Conclusions Patient's ABO blood group is associated with specific SVD types. We hypothesize that carbohydrate antigens, which may or may not be common to patient and animal bioprosthetic tissue, will determine a patient's specific immunoreactivity with respect to xenograft tissue and thus bioprosthesis outcome in terms of SVD.
背景 猪/牛与人有共同的抗原：α-Gal，存在于所有与人 B 抗原接近的猪/牛中；和 AH-组织血型抗原，与人类 AH 抗原相同，仅存在于某些动物中。我们通过植入时年龄≤60 岁的患者的生物假体结构退化（SVD）的钙化/肉芽/撕裂/穿孔来研究患者的 ABO 血型对生物假体的可能影响。
方法和结果 这是一项单中心研究（法国巴黎），包括 1985 年至 1998 年期间植入的所有退行性生物假体，主要是猪生物假体（Carpentier-Edwards 第二代/第三代猪生物假体）和一些牛生物假体。对于 1998 年至 2014 年期间，仅纳入了寿命≥13 年的猪生物假体（总随访时间≥29 年）。除了血型外，SVD 的重要预测因素也被前瞻性收集（植入年龄/寿命/数量/部位/性别/SVD 类型），并使用逻辑回归进行分析。500 个植入的猪生物假体均可进行所有变量分析。通过多变量分析，A 组与以下情况的风险增加相关：撕裂（比值比[OR]，1.61；=0.026）；肉芽（OR，1.5；=0.054），有撕裂的肉芽（OR，1.73；=0.037），且有较低风险的钙化（OR，0.63；=0.087）或孤立钙化（OR，0.67；=0.17）。A 抗原与穿孔的风险降低相关（OR 0.56；=0.087）。B 组患者穿孔的风险增加（OR，1.73；=0.043）；有钙化的肉芽（OR，3.0，=0.025）。B 抗原与一般的钙化倾向相关（OR，1.34；=0.25）。
结论 患者的 ABO 血型与特定的 SVD 类型相关。我们假设碳水化合物抗原可能与人或动物生物假体组织相同或不同，这将决定患者对异种移植物组织的特定免疫反应性，从而影响生物假体的 SVD 结果。
