Conclusion
With future growth of transcatheter technologies for aortic, mitral, and tricuspid valve pathologies, cardiac operations in elderly patients will continue to become more complex. Above studies prove the importance of preoperative risk assessment, frailty testing, functional status, and structural heart team approach for percutaneous, transcatheter, and open cardiac operations. Furthermore, they highlight the high inherent risk of performing any intervention on extreme elderly patients. Future operations will involve coronary revascularization for complex anatomic lesions with concomitant valvular interventions and/or valvular interventions not suitable for available percutaneous devices. Furthermore, studies have shown variable accuracy in the correct prediction of surgical risk in nonagenarian patients with the STS-PROM, EUROSCORE I and newer EuroSCORE II models. Furthermore, individualized patient and family discussions with palliative care teams are instrumental in clearly delineating postoperative expectations and goals of care which aids the decision-making process.