Observational studySurgery today2026
Early postoperative "grey zone" gradients following aortic valve replacement surgery: the clinical course and mechanical stress biomarker profile.
Observational study in Surgery today, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
4 authors.
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Abstract
purposeSurgeons 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.
methodsWe 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).
resultsThe 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).
conclusionEarly "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 registrationThis study was not registered as a clinical trial because it was a retrospective observational study.
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