• Francesco Onorati, Eduard Quintana, Zein El-Dean, Andrea Perrotti, Sandro Sponga, Vito Giovanni Ruggieri, Mauro Rinaldi, Aldo Domenico Milano, Francesco Santini, Sidney Chocron, Ugolino Livi, Stefano Salizzoni, Tommaso Loizzo, Antonio Salsano, Alessandro Di Cesare, Giuseppe Faggian, Manuel Castella, and Francesco Nicolini.
• Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy. Electronic address: francesco.onorati@univr.it.
• J. Cardiothorac. Vasc. Anesth. 2020 Aug 1; 34 (8): 2091-2099.

ObjectiveTo evaluate current results of surgical aortic valve replacement (SAVR) ± coronary artery bypass grafting surgery.DesignIndependent, multicenter, prospective registry.SettingTertiary university hospitals.ParticipantsThe study comprised 1,192 consecutive patients, stratified as low-, intermediate-, and high-risk according to EuroSCORE II (<4, 4-9, >9, respectively).InterventionsSAVR ± coronary artery bypass grafting surgery.Measurements And Main ResultsThirty-day mortality and major morbidity, 2-year actuarial survival and freedom from stroke, and independent predictors of mortality in each risk category were assessed. These data were considered in light of published randomized controlled trials. Thirty-day mortality was 1.0%, 3.0% and 2.1% in the low-, intermediate-, and high-risk patients, with a 2-year actuarial survival of 98.6%, 93.8%, and 94.0%, respectively. Preoperative atrial fibrillation (odds ratio [OR] 8.3), minithoracotomy access (OR 5.8), postoperative dialysis (OR 3.4), type V acute myocardial infarction (OR 20.4), and moderate aortic regurgitation (OR 28.8) predicted 30-day mortality in the low-risk group. Preoperative dialysis (OR 18.3), critical state (OR 36.7), postoperative transfusions of plasma (OR 1.9 per unit transfused), and de-novo dialysis (OR 6.2) predicted 30-day mortality in the intermediate-risk group. Prior cardiac surgery (OR 18.1), postoperative extracorporeal membrane oxygenation (OR 9.8), and gastrointestinal complications (OR 17.2) predicted 30-day mortality in the high-risk group. Although baseline differences existed, low-risk patients demonstrated low 30-day mortality and 30-day to 12-month stroke in light of the PARTNER 3 and EVOLUT Low Risk trial results. Intermediate-risk patients demonstrated low 30-day to 2-year mortality, when the PARTNER 2 trial was considered, and low 30-day to 2-year stroke, when the PARTNER 2 and SURTAVI trials were considered. High-risk patients showed low 30-day to 2-year mortality in light of the results of the PARTNER 1 and CoreValve US trials.ConclusionsSAVR is still a safe and effective surgery for aortic stenosis regardless of risk category.Copyright © 2020 Elsevier Inc. All rights reserved.

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