Perioperative Inflammation and Functional Recovery after Surgical Aortic and Mitral Valve Replacement: A Prospective...

Area of Science:

• Cardiovascular Surgery
• Immunology
• Biomaterials

Background:

• Cardiac valve surgery triggers systemic inflammation and variable ventricular recovery.
• The impact of prosthesis type on inflammatory responses and clinical outcomes is not well understood.

Purpose of the Study:

• To investigate the relationship between cardiac prosthesis type and perioperative inflammatory responses.
• To assess the influence of prosthesis type on early clinical outcomes and mid-term ventricular functional recovery after valve replacement.

Main Methods:

• A prospective observational study of 100 adults undergoing aortic or mitral valve replacement with either mechanical or bioprosthetic valves.
• Measurement of biochemical and inflammatory markers preoperatively, and on postoperative days 1 and 6.
• Assessment of early clinical outcomes and transthoracic echocardiography at baseline and 6 months.

Main Results:

• All patients showed a significant inflammatory surge on postoperative day 1, which partially normalized by day 6, irrespective of prosthesis type.
• No significant differences in early clinical outcomes (atrial fibrillation, acute kidney injury, 30-day mortality) were observed between mechanical and bioprosthetic valve groups.
• Mechanical valves showed lower mean transvalvular gradients and greater improvement in left ventricular ejection fraction (LVEF) at 6 months.
• Aortic valve replacement (AVR) and mechanical prostheses independently predicted greater LVEF improvement.

Conclusions:

• Perioperative inflammation following cardiac valve surgery is substantial but transient and not influenced by prosthesis type.
• Ventricular functional recovery is primarily determined by valve position and prosthesis hemodynamics.
• Mechanical AVR offers superior mid-term ventricular improvement compared to bioprosthetic valves.