Related Experiment Video
Updated: Aug 12, 2026

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Postoperative De Ritis Ratio as a Predictor of Adverse Outcomes After Combined Aortic and Mitral Valve Replacement: A
1Department of Cardiovascular Surgery, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey.
Background:
Double valve replacement (DVR) of both the aortic and mitral valves is a technically demanding cardiac procedure associated with significant risks, including extended cardiopulmonary bypass times and a pronounced systemic inflammatory response. The De Ritis ratio (aspartate aminotransferase/alanine aminotransferase), a biomarker of cellular injury, has emerged as a prognostic indicator in various clinical scenarios.
Aim:
The primary objective of this investigation is to elucidate the association between the postoperative De Ritis ratio and the incidence of complications among patients undergoing DVR.
Methods:
A retrospective cohort study was conducted, encompassing 120 consecutive patients who underwent DVR at our institution between October 2017 and October 2023. The De Ritis ratio was calculated from laboratory values obtained preoperatively and within the first 24 hours postoperatively. Patients were stratified into two groups (postoperative De Ritis ratio ≤1.5 vs. >1.5) to assess its association with adverse outcomes.
Results:
The mean age of the cohort was 58.2 ± 12.4 years. Patients with a postoperative De Ritis ratio >1.5 experienced a statistically significant prolongation of both their intensive care unit stay (4.8 ± 1.6 days vs. 3.2 ± 1.4 days, P = 0.01) and their overall hospital stay (14.3 ± 4.2 days vs. 9.5 ± 3.1 days, P = 0.008). The 30-day mortality rate was also significantly higher in the elevated De Ritis group (12% vs. 5%, P = 0.04).
Conclusion:
The postoperative De Ritis ratio independently predicts unfavorable outcomes after DVR. Its integration into routine postoperative risk stratification may enhance surveillance and optimize perioperative management.
Related Concept Videos
Aortic Regurgitation III: Medical Management
Aortic Regurgitation I: Introduction
Mitral Stenosis III: Medical Management
Aortic Regurgitation II: Clinical Features and Diagnostic Tests
Mitral Regurgitation III: Medical Management
Mitral Stenosis I: Introduction

