Background: Patients undergoing surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS) remain at considerable long-term risk for adverse cardiovascular events. Traditional surgical risk scores often fail to capture functional and subclinical predictors of late complications. Methods: We retrospectively analysed 101 consecutive patients who underwent isolated SAVR for severe AS from 2021 and 2023. Baseline demographic, clinical, laboratory, and echocardiographic data were collected. NACE was defined as a composite of all-cause mortality, stroke, myocardial infarction, or major bleeding during a 2-year follow-up. Results: Seventeen patients (16.8%) experienced a NACE. Compared to patients without events, those with NACE were older (p<0.001), had higher EuroSCORE II (p<0.001), worse renal function (p<0.001), and impaired LV systolic function as assessed by global longitudinal strain (p=0.01). Systolic pulmonary artery pressure (sPAP) was also significantly higher (p=0.004). At multivariate logistic regression, four variables independently predicted NACE: Age (95% CI 1.04-1.25, OR: 1.12, p=0.003); LV-GLS (95% CI 0.8-0.97, OR: 0.88, p=0.02); post operative serum creatinine (95% CI 1.2-1.76, OR: 1.45, p=0.001); sPAP (95% CI 1.01-1.22, OR: 1.08, p=0.03). GLS ≤14.5% identified patients at risk of NACE with an overall diagnostic accuracy of 72%. Conclusions: Impaired LV myocardial strain, postoperative renal dysfunction, older age, and elevated pulmonary pressures are independently associated with long-term adverse events after SAVR. These parameters may improve individual risk stratification beyond conventional scores and inform tailored postoperative surveillance.
Associazione Nazionale Medici Cardiologi Ospedalieri
