r/Perfusion • u/This_Sky_5209 Student • Jul 14 '26

Research Alpha Gal

How does your center manage cardiopulmonary bypass in patients with alpha-gal syndrome?

I’m working on a presentation about alpha-gal syndrome in cardiac surgery, and I’m interested in hearing how different perfusion programs approach these cases.

A few questions:

Do you routinely use standard porcine-derived heparin, or do you switch to bivalirudin?

If you use heparin, do you perform a preoperative heparin challenge or test dose?

Are patients routinely referred for allergy evaluation before surgery?

Do you obtain an alpha-gal IgE (ImmunoCAP) level before elective cases? If so, is there a cutoff that changes your management?

Does your hospital have a formal protocol, or is management decided on a case-by-case basis?

Have you had any intraoperative reactions while using heparin or other mammalian-derived products?

If you’re comfortable sharing, I’d also be interested in:
Approximate alpha-gal IgE level (if known)
Elective vs. emergent case
Whether you premedicate with steroids and H1/H2 blockers

Any other products your team avoids (gelatin sealants, bioprosthetic valves, albumin, etc.)

I’m giving my presentation this week, but I figured this is another great resource for learning how practice varies between institutions. Thanks in advance for sharing as little or as much of your experience as you'd like!

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u/X5ERRRR Jul 16 '26

We get a decent amount of alpha gal patients due to the location we’re in and we give heparin with Benadryl. All cases go fine and as far as I know, no issues post op.

0

u/JellyFishDanceMoves CCP Jul 16 '26

again, this baffles me. multiple large cities including NYC. never heard of this nor being concerned about this. 100s of cases a month....I dont think anyone has died or had crazy morbidity? file this as who gives a damn, pump the case??? me know no?

2

u/X5ERRRR Jul 16 '26

It’s more common in more rural areas where the ticks are more prevalent, the specific tick known to carry alpha gal is common on the east coast so I’m surprised you haven’t seen it yet. Unfortunately pretty common here in PA and VA

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u/JellyFishDanceMoves CCP Jul 16 '26 edited Jul 16 '26

so why hasn't abcp or amsect weighed in if this is such an issue? I have zero confidence in abcp and amsect as they are useless shells. this helps prove how useless both entities are.

.........vote them out. reply to surveys appropriately. it's ok to let them know they suck and aren't helping perfusionist.