**4. Analysis of surgical risk and evaluation of life expectancy and quality of life**

The precise evaluation of surgical risk in a specific patient is not easy and involves an at‐ tempt at individualization based on statistical data from databases containing a large num‐ ber of procedures. The most accepted and validated algorithms that are widely available today are the EuroSCORE, the STS (Society of Thoracic Score) score,and the Parsonnet score. These algorithms predict the surgical risk by assigning weight to various factors that affect the clinical result, but it is clear that they can underestimate or overestimate the risk in cer‐ tain groups of patients who are not represented satisfactorily in the population used to gen‐ erate the algorithm [8]. There is some evidence in the literature of the incorrect prediction of aortic AVR outcome using the EuroSCORE model [9]. The key element for establishing whether patients are at high risk for surgery is multidisciplinary clinical judgment, which should be used in association with a more quantitative assessment, based on the combina‐ tion of several scores (for example, expected mortality >20% with the EuroSCORE and >10% with STS score). This approach allows the team to take into account risk factors that are not covered in scores but often seen in practice, such as chest radiation, previous aortocoronary bypass with patent grafts, porcelain aorta, liver cirrhosis.
