Abstract
The aging population is increasing, and as a result there are a growing number of elderly patients presenting with senile degenerative calcific aortic stenosis. Advanced age alone cannot be considered a precluding factor for surgery. Medical treatment options are limited. Elderly patients who did not receive aortic valve replacement (AVR) presented a 12-fold increased mortality risk compared with surgically treated patients. Isolated AVR in octogenarians can be performed with a low overall pooled postoperative mortality of 6.7%. AVR in elderly patients results in significant healthrelated quality of life with improvement in cardiac symptoms and significant functional gains after surgery. Furthermore, econometric analysis has shown that AVR is cost-effective even for very elderly patients. Surgical decision-making in this selected population undergoing cardiac surgery is challenging because of the heterogeneity of comorbidity, disability/frailty, and life expectancy. Transcatheter aortic valve replacement (TAVR) and sutureless AVR are emerging alternatives to conventional surgery in selected high-risk surgical cases or inoperable patients. In regard to current decisionmaking for AVR, the difficulty is to translate from the risk score to the best surgical treatment possibilities tailored to the individual patient. The actual risk scores do not completely describe the elderly population. There is a demand to combine (1) cardiac surgery risk scores with (2) measures of frailty and disability, and (3) life expectancy to provide a more complete model for risk prediction. (1) In cardiac surgery, the European System for Cardiac Operative Risk Evaluation (euroSCORE) II, Society of Thoracic Surgeons (STS) score, and Parsonnet score are used the most. Their aim is to assess mortality and morbidity after cardiac surgery considering comorbidity and preoperative risk factors. The euroSCORE II and STS score have moderate discrimination for predicting 30-day mortality after TAVR. Moreover, these scores do not stratify the grade of aortic stenosis severity, based on left
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