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

Cardiac valve surgery induces systemic inflammation and variable ventricular recovery. Whether inflammatory responses differ by prosthesis type and influence clinical or functional outcomes remains unclear.

In this prospective observational study, 100 adults undergoing aortic valve replacement (AVR) or mitral valve replacement (MVR) received either mechanical (n = 50) or bioprosthetic (n = 50) valves. Biochemical and inflammatory markers were measured preoperatively, on postoperative day (POD) 1, and on POD 6. Early clinical outcomes were recorded. Transthoracic echocardiography was performed at baseline and 6 months.

Baseline characteristics were comparable between groups (age: 49.96 ± 9.88 years; baseline left ventricular ejection fraction [LVEF]: 48.97 ± 9.00%; EuroSCORE II: 3.64 ± 1.74). All patients exhibited a marked inflammatory surge on POD 1, with C-reactive protein increasing from 4.04 (2.83-5.33) to 59.98 (45.50-74.05) mg/L and interleukin-6 from 7.08 (5.91-8.28) to 118.53 (95.25-141.06) pg/mL, followed by partial normalization by day 6 (all P < 0.001). Inflammatory trajectories did not differ by prosthesis type. Early outcomes included atrial fibrillation in 32%, acute kidney injury in 16.0%, and 30-day mortality in 6.0%, without significant valve-group differences. At 6 months, mechanical valves demonstrated lower mean transvalvular gradients (5.77 ± 4.69 vs. 10.20 ± 5.18 mmHg; P = 0.001) and greater improvement in LVEF (ΔLVEF: 5.68 ± 2.99 vs. 3.83 ± 3.08%; P = 0.003). AVR (β = 2.80; P < 0.001) and mechanical prostheses (β = 2.50; P < 0.001) independently predicted greater ΔLVEF. Serum lactate predicted 30-day mortality (area under the curve: 0.846).

Perioperative inflammation is substantial but transient and unrelated to prosthesis type. Functional recovery is driven by valve position and prosthesis hemodynamics, with mechanical AVR conferring superior mid-term ventricular improvement.