Multiparametric Predictors of Adverse Outcomes After Savr: A 2–year Cohort Study

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.