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

OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.