Early postoperative “grey zone” gradients following aortic valve replacement surgery: the clinical course and mechanical stress biomarker profile
Surgery Today, cilt.56, sa.10, ss.2286-2294, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 56 Sayı: 10
- Basım Tarihi: 2026
- Doi Numarası: 10.1007/s00595-026-03359-0
- Dergi Adı: Surgery Today
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE, Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
- Sayfa Sayıları: ss.2286-2294
- Anahtar Kelimeler: Aortic valve replacement, Transvalvular gradient, Neutrophil-to-lymphocyte ratio, Lactate dehydrogenase, Prosthesis-patient mismatch
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Purpose: Surgeons frequently encounter early postoperative intermediate transvalvular gradients (20–40 mmHg, “grey zone”) after aortic valve replacement (AVR). We investigated whether these gradients compromise short-term clinical stability or represent a transient, clinically compensated phase, marked by systemic mechanical stress. Methods: We retrospectively evaluated 141 consecutive isolated AVR patients, stratified by pre-discharge mean gradients: Group 1 (> 20 mmHg, n = 66) and Group 2 (≤ 20 mmHg, n = 75). We analyzed short-term clinical outcomes and systemic mechanical stress markers (neutrophil-to-lymphocyte ratio [NLR] and lactate dehydrogenase [LDH] levels). Results: The operative characteristics were similar between the groups. Group 1 exhibited elevated median NLR (3.8 vs. 2.1, p < 0.001) and LDH (304.0 vs. 115.5 U/L, p < 0.001) levels. Despite this biochemical activation, the short-term mortality and reoperation rates were comparable between the two groups. Although Group 1 experienced more frequent non-valvular readmissions (13.6% vs. 2.6%, p = 0.024), their mean gradients demonstrated significant spontaneous regression by 6 months (23.5 to 19.8 mmHg, p < 0.01). Conclusion: Early “grey zone” gradients are associated with a distinct mechanical stress profile characterized by elevated NLR and LDH levels but do not appear to compromise short-term valvular stability. The spontaneous gradient regression and absence of excess mortality support a safe “watchful waiting” approach, thus avoiding premature reinterventions while maintaining close clinical surveillance. Clinical Trial Registration: This study was not registered as a clinical trial because it was a retrospective observational study.