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Aim: identification of predictors for adverse 30-day postoperative events.Hypothesis: postoperative results might improve if the development of these predictors can be prevented/avoided.Type: retrospective file study.Setting: general hospital, dept.Cardiovascular surgery.Patients: 1000 consecutive patients with degenerative aortic valve disease, median age 75 (71-77) years, 186 above 80 years.Operation: aortic valve replacement (AVR) with an CarpentierEdwards pericardial valve; 610 patients also received a CAB G.Outcome: 30 day mortality, thromboembolism, bleeding, congestive heart failure, ventricular arrhythmias, conduction defects, pulmonary complications, renal function impairment.Statistics: first step: screening of significant preoperative factors by an univariate Fisher-exact test; second step: identification of independent predictors bya multivariate logisticregression analysis.Results: Congestive heart failure is the most lethal complication (14/36) and thromboembolism has a devastating neurologic effect in most patients (25/37)complication Independent predictor P OR 95%CI Mortality (n=37) Urgent AVR <0.001 9.0 2.8-28.7 Digitalis 0.002 3.5 1.6-7.7 Age > 80 0.005 3.1 1.4-6.6 Congestive heart failure (n=36) Urgent AVR <0.001 10.5 3.6-30.8 AF 0.001 3.5 1.7-7.4 Ventricular arrhythrnia (n=37) AMI 0.025 2.4 1.1-5.0 EF<50% 0.032 2.2 1.1-4.4Thromboembolic event (n=27) EF<50% 0.027 2.5 1.1-5.7Bleeding (n=20) Concomitant CABG 0.046 3.6 1.0-1 2.5Pulmonary complications (n=5g) pacemaker implant 0.002 4.4 1.8-11.2COPD 0.050 1.7 1.0-3.1Renal function impairment (n=53) preop renal dysfunction <0.001 5.5 2.9-10.4Atrial fibrillation 0.010 2.3 1.2-4.2Age over 80 0.014 2.2 1.2-4.1Myocardial infarction 0.022 2.2 1.1-4.4Conclusions: need for urgent surgery is the dominant independent predictor for postoperative mortalityand congestive heart failure.It is a marker of advanced valvular heart disease with exhaustion of all compensatory mechanisms to maintain an adequate circulation.An EF below 50% is as another marker of advanced valvular heart disease with comparable consequences.We hypothesize that early referral for AVR could avoid the development of decrease in EF and of need for urgent AVR and thereby could improve postoperative results.