Mid-Term Clinical Outcomes and Predictors of Mortality and Major Adverse Cardiovascular Events Following Cardiac Valve Replacement Surgery: A Retrospective Cohort Study From a Tertiary Center in Iran.

Abstract

Objectives: Valvular heart disease (VHD) is a growing global health concern with increasing prevalence, particularly in aging populations. While surgical valve replacement (VRS) remains a definitive treatment, limited data exists from developing countries regarding postoperative outcomes. This study aimed to evaluate mid-term clinical outcomes, specifically survival and major adverse cardiovascular events (MACE), in patients undergoing isolated mitral and aortic valve replacement surgery, and to identify factors associated with mortality.

Methods: In this retrospective cohort study, 1044 patients who underwent isolated mitral or aortic VRS at Tehran Heart Center between 2003 and 2023 were analyzed. Demographic, clinical, and echocardiographic data were collected. The primary outcome was all-cause mortality; the secondary outcome was MACE. Statistical analyses included univariate and multivariate Cox regression, ROC curve analysis, and log-rank tests.

Results: The mean age of patients was 55 years, and 52% were male. Over a mean follow-up of 23.9 months, the overall mortality rate was 4.3%, and 8.4% experienced MACE. Multivariate analysis identified older age (p = 0.002) and female gender (p = 0.006) as independent predictors of mortality. Age > 50 years had a sensitivity of 85.5% and specificity of 34% for predicting mortality (AUC = 0.639, p = 0.001). No significant predictors of MACE were identified.

Conclusion: Advanced age and female gender were associated with increased mortality following isolated VRS. These findings underscore the importance of tailored preoperative risk assessment to optimize surgical outcomes, particularly in developing healthcare settings.