Background: The hemoglobin–albumin–lymphocyte–platelet (HALP) score is an emerging nutritional inflammatory biomarker. Although minimally invasive valve surgery (MIVS) offers advantages over sternotomy, current prediction models such as EuroSCORE II and STS-PROM may not fully capture perioperative vulnerability. Evidence evaluating whether HALP predicts early postoperative recovery in MIVS remains limited.

Methods: This single-center retrospective study included 139 adults undergoing MIVS between January 2020 and June 2025. Patients were stratified based on the median
HALP value (≤42.2 vs. >42.2). Baseline characteristics, operative data, and postoperative outcomes were compared. Correlations between HALP and operative risk indices (STS and EuroSCORE II), ventilation duration, intensive care unit (ICU) stay, and hospitalization length were assessed using Spearman’s analysis. Receiver-operating characteristic curves evaluated the ability of HALP to predict prolonged intubation and ICU stay.

Results: Higher HALP scores were associated with younger age, better functional status, and lower STS and EuroSCORE II values. Patients with HALP >42.2 had shorter intubation time (9.7 ± 13.3 vs. 16.6 ± 27.2 hours, P = .013) and ICU stay (2.3 ± 2.7 vs. 3.1 ± 3.0 days, P = .021). All in-hospital deaths occurred in the low-HALP group. The HALP score showed inverse correlations with STS (r = −0.351), EuroSCORE II (r = −0.296), intubation time (r = −0.236), and ICU duration (r = −0.231) (all P < .01). No significant association was observed with hospitalization time.

Conclusions: A low preoperative HALP score was associated with prolonged ventilation, extended ICU stay, and increased early mortality after MIVS. The HALP reflects biological resilience beyond conventional risk models and may serve as an accessible adjunct for risk stratification. Prospective multicenter studies are needed to confirm these findings and support its incorporation into clinical decision-making.