Recipients with blood group A associated with longer survival rates in cardiac valvular bioprostheses
O. Schussler,
N. Lila,
T. Perneger,
P. Mootoosamy,
J. Grau,
A. Francois,
D.M. Smadja,
Y. Lecarpentier,
M. Ruel,
A. Carpentier
Affiliations
O. Schussler
Division of Cardiovascular Surgery and Cardiovascular Research Laboratory, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Corresponding author at: Geneva University Hospitals, Department of Cardiac Surgery, 4 rue Gabriel Perret Gentil, 1214 Geneva 4, Switzerland.
N. Lila
Laboratory of Biosurgical Research (Alain Carpentier Foundation), University Paris Descartes, Sorbonne Paris Cité, Paris F-75475, France
T. Perneger
Department of Clinical Epidemiology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
P. Mootoosamy
Division of Cardiovascular Surgery and Cardiovascular Research Laboratory, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
J. Grau
Division of Cardiac Surgery and Research Laboratory, Department of Epidemiology, Ottawa Heart Institute, University of Ottawa Heart, Ottawa, Ontario, Canada.
A. Francois
Etablissement Français du Sang (EFS), Ile de France, Immuno-hematology Laboratory, Georges Pompidou Hospital, Paris, France
D.M. Smadja
Division of Cardiovascular Surgery and Cardiovascular Research Laboratory, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; AP-HP, Hôpital Européen Georges Pompidou, Hematology Department, Paris Descartes University, Sorbonne Paris Cite, Inserm UMR-S1140, Paris, France
Y. Lecarpentier
Centre de Recherche Clinique, Grand Hôpital de l'Est Francilien (GHEF), Meaux, France
M. Ruel
Division of Cardiac Surgery and Research Laboratory, Department of Epidemiology, Ottawa Heart Institute, University of Ottawa Heart, Ottawa, Ontario, Canada.
A. Carpentier
Laboratory of Biosurgical Research (Alain Carpentier Foundation), University Paris Descartes, Sorbonne Paris Cité, Paris F-75475, France; AP-HP, Hôpital Européen Georges Pompidou, Department of Cardiovascular Surgery, Paris, France
Background: Pigs/bovines share with humans some of the antigens present on cardiac valves. Two such antigens are: the major xenogenic Ag, “Gal” present in all pig/bovine very close to human B-antigen of ABO-blood-group system; the minor Ag, pig histo-blood-group AH-antigen identical to human AH-antigen and present by some animals. We hypothesize that these antigens may modify the immunogenicity of the bioprosthesis and also its longevity. ABO distribution may vary between patients with low (<6 years) and high (≥15 years) bioprostheses longevity. Methods: Single-centre registry study (Paris, France) including all degenerative porcine bioprostheses (mostly Carpentier-Edwards 2nd/3rd generation heart valves) explanted between 1985 and 1998 and some bovine bioprostheses. For period 1998–2014, all porcine bioprostheses with longevity ≥13 years (follow-up ≥29 years). Important predictive factors for bioprosthesis longevity: number, site of implantation, age were collected. Blood group and other variables were entered into an ordinal logistic regression analysis model predicting valve longevity, categorized as low (<6 years), medium (6–14.9 years), and high (≥15 years). Findings: Longevity and ABO-blood group were obtained for 483 explanted porcine bioprostheses. Mean longevity was 10.2 ± 3.9 years [0–28] and significantly higher for A-patients than others (P = 0.009). Using multivariate analysis, group A was a strong predictive factor of longevity (OR 2.09; P < 0.001). For the 64 explanted bovine bioprosthesis with low/medium longevity, the association, with A-group was even more significant. Interpretation: Patients of A-group but not B have a higher longevity of their bioprostheses. Future graft-host phenotyping and matching may give rise to a new generation of long-lasting bioprosthesis for implantation in humans, especially for the younger population. Fund: None.
