Preoperative platelet-related inflammatory burden is associated with delayed early hemodynamic recovery following minimally invasive cardiac surgery

Minimally invasive cardiac surgery (MICS) is associated with reduced surgical trauma and improved postoperative recovery; however, early hemodynamic recovery remains variable and may be influenced by patient-related biological factors. This study evaluated the association between preoperative inflammatory biomarkers and delayed early postoperative recovery following MICS. This retrospective observational study included 166 consecutive patients undergoing thoracotomy-based MICS at a single tertiary center between January 2020 and January 2026. Preoperative inflammatory indices, including platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII), were calculated from routine laboratory parameters. The primary endpoint was prolonged postoperative inotropic support (> 24 h); vasopressor-only therapy administered for vasoplegia or isolated blood pressure support was not counted. Multivariable complete-case logistic regression ( n = 154), receiver operating characteristic (ROC) analysis, and sensitivity analyses were performed. Prolonged inotropic support was needed in 41 patients (24.7%). Patients requiring prolonged support were older, had a higher prevalence of hypertension, and had longer cardiopulmonary bypass duration in univariable comparisons. LVEF was numerically lower but did not reach conventional statistical significance. PLR and SII were significantly higher in these patients ( p = 0.003 and p = 0.010, respectively). In separate adjusted models, both PLR > = 142 and SII > = 462 were associated with prolonged support. In the combined complete-case model including both biomarkers, PLR > = 142 remained independently associated with prolonged support (OR 4.18, 95% CI 1.30–13.40, p = 0.016), whereas SII > = 462 did not (OR 1.66, 95% CI 0.52–5.31, p = 0.391). ROC analysis showed modest discrimination (PLR AUC 0.655, 95% CI 0.564–0.753, p = 0.003; SII AUC 0.634, 95% CI 0.538–0.729, p = 0.010). No significant associations were observed between inflammatory biomarkers and early mortality, acute kidney injury, or postoperative atrial fibrillation. Preoperative platelet-related inflammatory burden, as reflected by PLR, was associated with delayed early postoperative hemodynamic recovery following MICS. However, the discriminatory performance of PLR was modest, and this biomarker should be interpreted as a complementary risk indicator rather than a stand-alone decision-making tool. These findings are exploratory and require prospective validation in independent cohorts.