Abstract: 【Abstract】 Objective To determine risk factors associated with the outcomes of heart valve replacement, especially in the patients with rheumatic heart disease (RHD). Methods Data were extracted from 2 696 patients who received valve replacement from August 2012 to January 2015. Spearman correlation analyses were performed to identify potential risk factors. Logistic regression models were established to determine risk factors associated with deaths and complications. Results Duration of cardiopulmonary bypass (CPB) 〔standard partial regression coefficient ( B’)=0.418〕, heart function ( B’=0.344) and pulmonary hypertension ( B’=0.285) were significant predictors of deaths in hospitals. The prevalence of complications was associated with heart function ( B’=0.520), pulmonary hypertension ( B’=0.365), CPB duration ( B’=0.306), diabetes ( B’=0.129), left ventricular diameter ( B’=0.118) and pulmonary regurgitation B’=0.071). For patients with RHD, significant predictors of complications included heart function ( B’=0.578), pulmonary hypertension ( B’=0.401), CPB duration ( B’=0.305) and diabetes ( B’=0.143). Left ventricular ejection fraction was not significant in the regression models. Conclusion Chronic renal failure, heart function and CPB duration are associated with postoperative deaths in patients with heart valve replacement, while diabetes, heart function and pulmonary hypertension are significant predictors of postoperative complications. For RHD patients, diabetes, heart function and pulmonary hypertension are major risk factors associated with postoperative complications.