PT  - JOURNAL ARTICLE
AU  - Karim Hussien El-Shakankery
AU  - Luis Mieiro
TI  - A key role for comprehensive geriatric assessment in aortic valve replacement
AID  - 10.1136/bcr-2020-237031
DP  - 2020 Dec 01
TA  - BMJ Case Reports
PG  - e237031
VI  - 13
IP  - 12
4099  - http://casereports.bmj.com/content/13/12/e237031.short
4100  - http://casereports.bmj.com/content/13/12/e237031.full
SO  - BMJ Case Reports2020 Dec 01; 13
AB  - As our population ages, the demand for surgical services in older people is increasing exponentially. Shown to be indispensable in the care of medical patients, use of the comprehensive geriatric assessment (CGA) is also growing in the perioperative setting. We present the case of a previously independent 82-year-old man who underwent a standard preoperative assessment and surgical aortic valve replacement. In the 7 months that followed, prior to his death, he suffered a rapid functional decline contributed to by slow postoperative recovery, delirium and recurrent falls. Post-mortem revealed cardiac amyloid deposition and extensive small vessel disease in the brain. This case highlights the importance of the CGA in the perioperative management of older patients, especially in identification and optimisation of geriatric syndromes and consideration of less-invasive alternative treatments. We review the existing literature on CGA use in cardiothoracic and vascular surgical settings, drawing on experiences learnt from the above case.