Table 7.

Decision Making Algorithm. TAVI for older patients.

Supported by EACTS/ESC Guidelines from 2021 [6]	Supported by ACC/AHA Guidelines from 2020 [5]
-Class I for patients at high risks (STS-PROM/EuroSCORE II > 8%), unsuitable for surgery and ≥75 years -Class IIb non-trans femoral TAVI may be considered for inoperable or unsuitable for TF- TAVI and balloon dilatation may be seen as a bridge to SAVR or TAVI	-Class 1 for symptomatic 65–80 years: shared decision for the type of approach: SAVR or TF- TAVI -Class 1 for symptomatic octogenarians with life expectancy <10 years with or without depressed LVEF (<50%) -Class 1 for any age with surgical prohibitive risks and life expectancy >12 months -Class 2b for critically ill patients, balloon dilatation may be considered as a bridge to SAVR or TAVI.
Pros	Cons
-Less invasive procedure -Option for patients already operated -In some cases of chest irradiation, porcelain aorta or chest deformation -Multiples access possible	-Lack of long-term data -Higher risk of AVC and paravalvular leak -Infective endocarditis -Bacteriemia -Aortic insufficiency without stenosis -Prohibitive annular size -No aortic access -Intracardiac mass or thrombus -Mobile aortic atheroma -Inability to be anticoagulated -Lack of TAVI Team or Hybrid OR -Unicuspidal and some of bicuspid types valves -Resource demanding procedure (costly)