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Until the decade of 1980-1990 cardiac surgery was considered an exceptional option in octogenarian patients. This conservative attitude for elderly subjects, considered to be at high risk for frequent associated extracardiac pathologies, was progressively modified thanks to the progress observed in different medical and paramedical specialties. Objectively, there was a positive evolution of cardiovascular diagnostic procedures, anesthetic, surgical and intensive care techniques, including biomarkers and new drugs. Concomitantly, the extracorporeal circulation material was perfected and new methods of circulatory assistance and myocardial protection were created. Finally, knowledge of valve prosthesis long term results led to a change in the attitude of the medical community towards cardiac surgery in octogenarian patients. (1, 2) Valve diseases in elderly patients are mainly represented by severe calcified aortic valve stenosis. Mitral valve diseases, usually degenerative mitral insufficiency, are rarer. The prognosis of the spontaneous evolution of severe aortic stenosis is death in the short term since onset of symptoms as heart failure, angina, syncope and acute pulmonary edema. Surgery is indicated in the face of this spontaneous evolution. A bioprosthesis is recommended after 70 years of age to reduce the frequency of thromboembolic or hemorrhagic complications, and according to its theoretical durability it may not surpass the patient ́s lifetime. The problem of a reintervention due to tissue deterioration is always a possibility, but of less magnitude in elderly patients. As shown by the work by Pipkin et al. (3) at the Hospital Universitario Fundación Favaloro, the evolution of surgical techniques and postoperative care currently enables aortic valve replacement surgery in an important part of the population represented by octogenarian patients who suffer from an invalidating cardiomyopathy with bad prognosis despite medical treatment. Surgical risk is not negligible, so there should be great precision in the careful selection of surgical candidates, with the help of the geriatrician. Patients not presenting associated pathologies susceptible of considerably increasing surgical risk and post-

Reemplazo valvular aórtico en edad avanzada: necesidad de procedimientos multidisciplinarios complementarios