Oct 6, 2026 · 52 min · 9 segments
Dr Commins is joined by two cardiothoracic surgeons, Drs Turek and Kucera, who have replaced heart valves in over 100 patients with AGS. These two experts answer questions about this controversial and…
Joe TurekGuest
Scott ComminsHost
So I, I think it's, you know, it's ki- it's an interesting path that we, that we took.
Um, so as I mentioned before, we have a, a cardiac transplant immunology laboratory, and w- when you're talking about transplant immunology, you're talking about things like, all right, if I do a standard, you know, human heart transplant, uh, what are some of the things we can look at from a, from an immunologic standpoint with rejection and things? Um, but then also what if we look into xenotransplantation, you know, which is, they've, you know, we've talked about forever as being the future and always will be the future.
A- and, and so what they've done in xenotransplantation is they've realized that there's a lot of different types of antigens that come from other animals, if you're going to use, for example, a pig heart to put into a human, and those antigens are, are highly reactive 'cause they're cross-species.
Um, and, and it's, it's interesting, so they started developing pigs that were genetically modified, and what we modify them to do is to get rid of some of these really highly reactive antigens.
Well, what is one of the major antigens that we knock out when we develop these genetically modified pigs that we can hopefully use their hearts for, for human transplantation? Um, the most, uh, reactive alpha galactoses.
And so we, we, you know, so we've been doing some of that work with, with xenotransplantation, and I thought to myself, you know, it's interesting.
We worry about knocking all these things out when we use whole hearts and we transplant, you know, we're talking about transplanting a whole animal heart, yet we're still using, we're still using pig or cow val- uh, per- pericardium, the sac around their heart, to create valves, and those are our bioprosthetic valves that we use, heart valves that we use for patients are coming-
And so I thought, wow, that's kinda strange, you know? That, you know, I, I wonder if that would cause, you know, this.
I thought, oh, well, for sure there's post-processing type of, you know, things that they do.
They must get rid of all of these, these xenoantigens, um, you know, that are present.
I said, "Well, but let's, let's look at it." So we actually, um, we pulled off the shelf all of the different products that we have, whether it's cardiac patch tissue made from, you know, porcine or, or, or bovine pericardium, uh, the valves that were out there from all the different suppliers and everything- And we tested them, and we looked, said, "How much alpha-gal is still on these things?" The ones that come right off the shelf that go into our, our h- patients.
And we published a paper in, uh, 2022 in the Journal of Thoracic and Cardiovascular Surgery looking at this, and they were all littered with alpha-gal residues.
So I, I think it's, you know, it's ki- it's an interesting path that we, that we took.
Um, so as I mentioned before, we have a, a cardiac transplant immunology laboratory, and w- when you're talking about transplant immunology, you're talking about things like, all right, if I do a standard, you know, human heart transplant, uh, what are some of the things we can look at from a, from an immunologic standpoint with rejection and things? Um, but then also what if we look into xenotransplantation, you know, which is, they've, you know, we've talked about forever as being the future and always will be the future.
A- and, and so what they've done in xenotransplantation is they've realized that there's a lot of different types of antigens that come from other animals, if you're going to use, for example, a pig heart to put into a human, and those antigens are, are highly reactive 'cause they're cross-species.
Um, and, and it's, it's interesting, so they started developing pigs that were genetically modified, and what we modify them to do is to get rid of some of these really highly reactive antigens.
Well, what is one of the major antigens that we knock out when we develop these genetically modified pigs that we can hopefully use their hearts for, for human transplantation? Um, the most, uh, reactive alpha galactoses.
And so we, we, you know, so we've been doing some of that work with, with xenotransplantation, and I thought to myself, you know, it's interesting.
We worry about knocking all these things out when we use whole hearts and we transplant, you know, we're talking about transplanting a whole animal heart, yet we're still using, we're still using pig or cow val- uh, per- pericardium, the sac around their heart, to create valves, and those are our bioprosthetic valves that we use, heart valves that we use for patients are coming-
And so I thought, wow, that's kinda strange, you know? That, you know, I, I wonder if that would cause, you know, this.
I thought, oh, well, for sure there's post-processing type of, you know, things that they do.
They must get rid of all of these, these xenoantigens, um, you know, that are present.
I said, "Well, but let's, let's look at it." So we actually, um, we pulled off the shelf all of the different products that we have, whether it's cardiac patch tissue made from, you know, porcine or, or, or bovine pericardium, uh, the valves that were out there from all the different suppliers and everything- And we tested them, and we looked, said, "How much alpha-gal is still on these things?" The ones that come right off the shelf that go into our, our h- patients.
And we published a paper in, uh, 2022 in the Journal of Thoracic and Cardiovascular Surgery looking at this, and they were all littered with alpha-gal residues.
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