Key result
Postoperative De Ritis ratio >1.5 linked to ~2.4-fold higher 30-day mortality after double valve replacement.
Why the study?
The prognostic value of the postoperative De Ritis ratio for predicting complications after combined aortic and mitral valve replacement was unclear.
Does an elevated postoperative De Ritis ratio (>1.5) predict adverse outcomes in patients undergoing combined aortic and mitral valve replacement?
Cohort (n=120)
No
Does an elevated postoperative De Ritis ratio (>1.5) predict adverse outcomes in patients undergoing combined aortic and mitral valve replacement?
Absolute Event Rate: 12% vs 5%
p-value: p=0.04
An elevated postoperative De Ritis ratio (>1.5) is a simple and accessible biomarker that independently predicts prolonged hospitalization and increased 30-day mortality following double valve replacement.
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.
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Badak et al. (2026) conducted a cohort in Patients undergoing combined aortic and mitral valve replacement (double valve replacement) (n=120). Postoperative De Ritis ratio >1.5 vs. Postoperative De Ritis ratio ≤1.5 was evaluated on 30-day mortality (p=0.04). A postoperative De Ritis ratio >1.5 after double valve replacement was associated with significantly higher 30-day mortality compared to a ratio ≤1.5 (12% vs. 5%, P=0.04).
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