{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T07:11:44Z","timestamp":1763536304841,"version":"build-2065373602"},"reference-count":41,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T00:00:00Z","timestamp":1728432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Introduction and objectives: Aortic valve replacement surgery (SAVR) remains a recommended indication, though its pre-surgical stratification is an ongoing challenge. Despite the widespread use of scores like the STS and EuroSCORE II, they have a number of limitations, while often neglecting structural parameters like left ventricular hypertrophy or left atrium volume. This study aimed to evaluate whether a new adaptation of the G\u00e9n\u00e9reux classification in the preoperative risk stratification of severe aortic stenosis (AS) is associated with the primary outcome, and to compare it with the original classification versus the traditional scores in short- and long-term follow-up. Methods: We conducted a retrospective, single-center study involving patients with confirmed severe AS who underwent SAVR. The new stratification categorized patients into three stages. Cox regression analyses were conducted to identify factors associated with mortality, with survival analysis performed using Kaplan\u2013Meier curves. A p-value &lt; 0.05 was considered statistically significant. Results: A total of 508 patients were included. Stage 3 patients had a lower median age (67 years). The median EuroSCORE II and STS scores were 2.75 and 2.62%, respectively (p \u2264 0.001). Over a median follow-up of 81 months, 56 deaths occurred (11%). Kaplan\u2013Meier curve analysis revealed significant differences in all-cause mortality among the three groups (HR 4.073, log-rank p \u2264 0.001). Multivariable analysis identified the three preoperative stages (HR 3.22, [95% CI 1.44\u20137.20], p = 0.004) and mean transaortic gradient (HR 0.96, [95% CI 0.92\u20130.99], p = 0.021) as independent variables of mortality. The original G\u00e9n\u00e9reux scale AUC was higher (AUC: 0.760, 95% CI: 0.692\u20130.829) compared to the modified G\u00e9n\u00e9reux scale (AUC: 0.758, 95% CI: 0.687\u20130.829). However, no statistical differences were found between the different scales. Conclusions: Preoperative three-stage classification and low transaortic gradient are factors associated with increased all-cause mortality in patients undergoing SAVR. The proposed staging system performed better in the mortality analysis than EuroSCORE II and STS and was similar to the original classification.<\/jats:p>","DOI":"10.3390\/diagnostics14192250","type":"journal-article","created":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T12:22:48Z","timestamp":1728476568000},"page":"2250","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of a New Preoperative Stratification Based on Cardiac Structural Compromise in Patients with Severe Aortic Stenosis Undergoing Valve Replacement Surgery"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0191-7358","authenticated-orcid":false,"given":"Cristhian","family":"Espinoza Romero","sequence":"first","affiliation":[{"name":"Instituto do Cora\u00e7\u00e3o (InCor), Hospital das Cl\u00ednicas HCFMUSP, Faculdade de Medicina, Universidade de S\u00e3o Paulo, S\u00e3o Paulo 05403-904, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6521-2870","authenticated-orcid":false,"given":"Vitor Emer Egypto","family":"Rosa","sequence":"additional","affiliation":[{"name":"Instituto do Cora\u00e7\u00e3o (InCor), Hospital das Cl\u00ednicas HCFMUSP, Faculdade de Medicina, Universidade de S\u00e3o Paulo, S\u00e3o Paulo 05403-904, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S\u00e9rgio","family":"Octavio Kormann","sequence":"additional","affiliation":[{"name":"Instituto do Cora\u00e7\u00e3o (InCor), Hospital das Cl\u00ednicas HCFMUSP, Faculdade de Medicina, Universidade de S\u00e3o Paulo, S\u00e3o Paulo 05403-904, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan","family":"Nicolalde","sequence":"additional","affiliation":[{"name":"Norwalk Hospital-Yale University Program, Norwalk, CT 06856, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio S\u00e9rgio","family":"de Santis Andrade Lopes","sequence":"additional","affiliation":[{"name":"Instituto do Cora\u00e7\u00e3o (InCor), Hospital das Cl\u00ednicas HCFMUSP, Faculdade de Medicina, Universidade de S\u00e3o Paulo, S\u00e3o Paulo 05403-904, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guilherme","family":"Sobreira Spina","sequence":"additional","affiliation":[{"name":"Instituto do Cora\u00e7\u00e3o (InCor), Hospital das Cl\u00ednicas HCFMUSP, Faculdade de Medicina, Universidade de S\u00e3o Paulo, S\u00e3o Paulo 05403-904, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jo\u00e3o Ricardo","family":"Cordeiro Fernandes","sequence":"additional","affiliation":[{"name":"Instituto do Cora\u00e7\u00e3o (InCor), Hospital das Cl\u00ednicas HCFMUSP, Faculdade de Medicina, Universidade de S\u00e3o Paulo, S\u00e3o Paulo 05403-904, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flavio","family":"Tarasoutchi","sequence":"additional","affiliation":[{"name":"Instituto do Cora\u00e7\u00e3o (InCor), Hospital das Cl\u00ednicas HCFMUSP, Faculdade de Medicina, Universidade de S\u00e3o Paulo, S\u00e3o Paulo 05403-904, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-2426","authenticated-orcid":false,"given":"Roney Orismar","family":"Sampaio","sequence":"additional","affiliation":[{"name":"Instituto do Cora\u00e7\u00e3o (InCor), Hospital das Cl\u00ednicas HCFMUSP, Faculdade de Medicina, Universidade de S\u00e3o Paulo, S\u00e3o Paulo 05403-904, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"ESC\/EACTS Scientific Document Group, 2021 ESC\/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"43","author":"Vahanian","year":"2022","journal-title":"Eur. 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Surg."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/19\/2250\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:10:01Z","timestamp":1760112601000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/19\/2250"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,9]]},"references-count":41,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["diagnostics14192250"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14192250","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2024,10,9]]}}}