What is the clinical evidence from this study?

Study design: Cohort. Population: Severe aortic stenosis (n=81). Intervention: Sutureless aortic valve replacement (Su-AVR). Primary outcome: Early mortality (30-day and in-hospital) (p=<0.001).

What question did this study set out to answer?

This study evaluates the relationship between preoperative monocyte/HDL cholesterol ratio and early mortality in patients undergoing sutureless aortic valve replacement for aortic stenosis.

April 28, 2026Open Access

Retrospective cohort study: association of Monocyte/HDL cholesterol ratio with early mortality in patients undergoing sutureless aortic valve replacement for aortic stenosis

Q: What are the key findings of this study?

Preoperative Monocyte/HDL cholesterol ratio was significantly higher (1.07 vs 0.49) in patients with early mortality after sutureless aortic valve replacement, but regression was non-significant.

Q: What question did this study set out to answer?

This study evaluates the relationship between preoperative monocyte/HDL cholesterol ratio and early mortality in patients undergoing sutureless aortic valve replacement for aortic stenosis.

Key Result

Preoperative Monocyte/HDL cholesterol ratio was significantly higher (1.07 vs 0.49) in patients with early mortality after sutureless aortic valve replacement, but regression was non-significant.

Key Points

This study evaluates the relationship between preoperative monocyte/HDL cholesterol ratio and early mortality in patients undergoing sutureless aortic valve replacement for aortic stenosis.
Retrospective evaluation of patients undergoing Su-AVR from 2019 to 2024, excluding those with certain comorbidities.
Analysis of demographic data, EuroSCORE II values, laboratory results, and early mortality data from 81 patients.
Calculation of monocyte/HDL cholesterol ratio from preoperative laboratory values.
Early 30-day and in-hospital mortality rate was 4.9% (n = 4).
Lower eGFR and HDL levels were associated with higher MHR in patients who died (p = 0.011; p = 0.034; p < 0.001).
Low eGFR levels were significantly associated with mortality (OR: 0.944; p = 0.025), while MHR was not statistically significant (p = 0.986).

Study Design

Type

Cohort (n=81)

Multicenter

Structured PICO

Does preoperative Monocyte/HDL cholesterol ratio (MHR) predict early mortality in patients undergoing sutureless aortic valve replacement for severe aortic stenosis?

Population

81 patients with severe aortic stenosis who underwent elective isolated sutureless aortic valve replacement (Su-AVR) through median sternotomy. Median age 69, 58% female. Exclusions: emergency surgery, <18 years of age, pregnant or lactating, previous cardiac surgery, concomitant additional cardiac intervention, active or chronic infection, liver dysfunction, autoimmune disease, or malignancy.

Intervention

Preoperative Monocyte/HDL cholesterol ratio (MHR) assessment

Outcome

Early mortality (all-cause death in the first 30 days or during the hospital stay)hard clinical

While preoperative MHR is elevated in patients experiencing early mortality after sutureless aortic valve replacement, its independent predictive value remains unconfirmed due to small sample sizes.

Main Result

p-value: p=<0.001

Limitations

Retrospective, single-center design
Small sample size and low number of cases in the mortality group
Lack of data on CK-MB levels, electrocardiographic changes, and high-sensitivity troponin T
Short follow-up period limited to the early phase

Abstract

This study aims to evaluate the association of preoperative monocyte/HDL cholesterol ratio (MHR) with early mortality in patients undergoing elective isolated sutureless aortic valve replacement (Su-AVR) for severe aortic stenosis. Patients who underwent Su-AVR at our clinic between 2019 and 2024 were retrospectively evaluated. Patients meeting criteria such as emergency surgery, a history of previous cardiac surgery, active infection, liver dysfunction, malignancy, or autoimmune disease were excluded from the study. The demographic data, Logistic EuroSCORE II values, preoperative laboratory results, cardiopulmonary bypass (CPB) and aortic cross-clamping durations, postoperative complications, and early (30-day and in hospital) mortality data of the 81 patients included in the study were analyzed. MHR was calculated as the ratio of monocyte count (10³/L) to HDL cholesterol (mmol/L) levels. The median age of the patients was 69, and 58% were female. The early 30-day and in-hospital mortality rate was 4.9% (n = 4). In patients who died, eGFR and HDL levels were significantly lower, while monocyte count and MHR values were significantly higher (p = 0.011; p = 0.034; p < 0.001, respectively). In univariate regression analysis, only low eGFR levels showed a significant association with mortality (OR: 0.944; p = 0.025). MHR was not found to be statistically significant despite a high odds ratio (p = 0.986). Preoperative MHR levels in patients undergoing Su-AVR may be associated with early mortality; however, given the small number of cases, these findings should be considered preliminary. Additional studies involving larger patient cohorts are needed to confirm the role of MHR in risk stratification following Su-AVR.

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