title: [ANMCO/SIC/SICI-GISE/SICCH Consensus document: Risk stratification in elderly patients undergoing cardiac surgery and transcatheter aortic valve implantation].
abstract: Aortic stenosis is one the most frequent valvular diseases in developed countries, and its impact on public healthcare resources and assistance is increasing. A substantial proportion of elderly patients with severe aortic stenosis is frequently not eligible for surgery because of advanced age, frailty and multiple comorbidities. Transcatheter aortic valve implantation (TAVI) enables the treatment of very elderly patients at high or prohibitive surgical risk considered ineligible for surgery and with an acceptable life expectancy. However, a significant proportion of patients die or do not achieve an improvement of quality of life in the short to medium-term follow-up. It is important to determine: 1) whether and how much patient frailty influences the procedural risk; 2) whether quality of life and the individual patient survival are influenced by aortic valve disease alone or by other associated factors; 3) whether a geriatric specialist intervention to evaluate and correct other diseases with their potential or already evident disabilities can improve the results of TAVI, in particular patient quality of life. Consequently, in addition to risk stratification with conventional tools, a number of factors including multimorbidity, disability, frailty and cognitive function should be considered in order to assess the expected benefit of TAVI. Preoperative optimization through a multidisciplinary approach with a Heart Team can counteract the multiple damage (cardiac, neurological, muscular, respiratory, renal) that can potentially worsen the reduced physiological reserves characteristic of frailty. The systematic implementation into clinical practice of multidimensional assessment instruments of frailty and cognitive function for screening and exercise, and the adoption of specific care pathways should facilitate this task.
authors.affiliation: U.O.C. Cardiologia 1, Ospedale San Camillo-Forlanini, Roma.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pulignano
authors.affiliation: U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania.
authors.forename: Michele Massimo
authors.initials: MM
authors.lastname: Gulizia
authors.affiliation: Cardiologia Generale, AOU Careggi, Firenze.
authors.forename: Samuele
authors.initials: S
authors.lastname: Baldasseroni
authors.affiliation: U.O. Cardiologia-UTIC, IRCCS Policlinico San Donato, San Donato Milanese (MI).
authors.forename: Francesco
authors.initials: F
authors.lastname: Bedogni
authors.affiliation: U.O. Cardiologia e Medicina, Casa di Cura Villa Bianca, Trento.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cioffi
authors.affiliation: U.O. Cardiologia - Campus Universitario, Azienda Ospedaliera Universitaria Mater Domini, Catanzaro.
authors.forename: Ciro
authors.initials: C
authors.lastname: Indolfi
authors.affiliation: U.O.C. Cardiologia e Cardiologia Interventistica, Policlinico "Tor Vergata", Roma.
authors.forename: Francesco
authors.initials: F
authors.lastname: Romeo
authors.affiliation: Cardiologia e Fisiopatologia Cardiovascolare, Azienda Ospedaliera di Perugia, Perugia.
authors.forename: Adriano
authors.initials: A
authors.lastname: Murrone
authors.affiliation: U.O.C. Cardiochirurgia, Ospedale San Camillo-Forlanini, Roma.
authors.forename: Francesco
authors.initials: F
authors.lastname: Musumeci
authors.affiliation: U.O. Cardiochirurgia, Centro Cardiologico Monzino IRCCS, Università degli Studi, Milano.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Parolari
authors.affiliation: Presidio Cardiologico Cardiochirurgico (Centro Cuore), Centro Clinico Diagnostico G.B. Morgagni, Pedara (CT).
authors.forename: Leonardo
authors.initials: L
authors.lastname: Patanè
authors.affiliation: U.O. Cardiologia 2, Ospedale San Camillo-Forlanini, Roma.
authors.forename: Paolo Giuseppe
authors.initials: PG
authors.lastname: Pino
authors.affiliation: U.O. Cardiologia - Campus Universitario, Azienda Ospedaliera Universitaria Mater Domini, Catanzaro.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Mongiardo
authors.affiliation: U.O. Cardiologia - Campus Universitario, Azienda Ospedaliera Universitaria Mater Domini, Catanzaro.
authors.forename: Carmen
authors.initials: C
authors.lastname: Spaccarotella
authors.affiliation: U.O. Cardiochirurgia, Ospedale Policlinico S. Orsola-Malpighi, Bologna.
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
authors.affiliation: Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Musumeci
mesh_terms: D000367:Age Factors; D000368:Aged; D000465:Algorithms; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000592:standards*; D003663:Decision Trees; D006801:Humans; D018579:Patient Selection; D018570:Risk Assessment; D065467:Transcatheter Aortic Valve Replacement / Q000592:standards*; D016896:Treatment Outcome