Search Results (403)

Background: The treatment paradigm for relapsed/refractory (R/R) large B-cell lymphoma (LBCL) has undergone significant change with the advent of CD19-directed chimeric antigen receptor T-cell (CAR-T) therapies and CD20 × CD3 bispecific antibodies (BsAbs). Although both approaches have shown high response rates in single-arm studies, the absence of prospective randomized head-to-head comparisons has resulted in true clinical equipoise. Methods: A narrative synthesis was conducted, incorporating pivotal and updated phase 2 and 3 trial data, real-world evidence, and published meta-analyses. Results: In the second-line setting, CAR-T therapy demonstrates superior event-free survival, progression-free survival, and overall survival compared to standard-of-care chemo-transplant regimens. In the third-line setting, a pooled meta-analysis indicates significantly higher complete response rates for CAR-T compared with BsAbs, as well as superior 12-month progression-free survival. BsAbs provide immediate availability, greater accessibility, more favorable neurotoxicity profiles, and are feasible for frail or elderly patients. Real-world data show that BsAb complete response rates are consistently lower than those observed in clinical trials, whereas CAR-T real-world effectiveness closely aligns with pivotal trial outcomes. Emerging phase 3 data on fixed-duration and monotherapy bispecific regimens suggest that a genuine, if less mature, curative fraction may also be achievable among BsAb-treated complete responders. Conclusions: CAR-T therapy remains the standard of care for fit, eligible patients with R/R LBCL in second- and third-line settings with curative intent, providing superior depth and durability of response and a growing potential for long-term cure. BsAbs constitute a critical therapeutic alternative for patients ineligible for CAR-T, those with rapidly progressive disease, frail or elderly individuals, and as bridging strategies. A patient-centered, scenario-specific clinical decision framework is recommended. Full article

Background: Older adults with cancer are at increased risk of severe treatment-related toxicity. CARG, CRASH, and CARG-BC were developed as toxicity-risk prediction models, whereas G8 was developed as a geriatric screening instrument but has also been evaluated as a predictor of treatment-related toxicity. This study aimed to assess, separately for each instrument, the accuracy with which these tools identify older adults who develop severe chemotherapy-related toxicity. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. Seven databases were searched through May 2026 for observational studies evaluating the predictive accuracy of the CARG, CRASH, CARG-BC and G8 tools in patients aged ≥65 years initiating chemotherapy. Pooled sensitivity and specificity with 95% confidence intervals (CIs) were calculated, and ROC curves were constructed. Risk of bias was assessed using QUADAS-2 and certainty of evidence was evaluated using GRADE. Results: Twenty-one studies were included, with an overall toxicity prevalence of 52.6%. CARG demonstrated a pooled sensitivity of 79.7% and specificity of 38.3% (AUC = 0.632). CRASH showed sensitivity of 86.9% and specificity of 68.2% (AUC = 0.866), but estimates were based on only four studies. CRASH hematological toxicity showed sensitivity of 75.9% and specificity of 53.1% (AUC = 0.694), with substantial heterogeneity. G8 yielded sensitivity of 69.5% and specificity of 41.5% (AUC = 0.666). CARG-BC showed sensitivity of 83.3% and specificity of 54.4% (AUC = 0.763), based on two breast cancer studies. Certainty of evidence ranged from low to very low. Conclusions: The instruments have distinct purposes and were not pooled against one another. CARG and G8 may be useful for initial risk screening, whereas CRASH showed a more balanced profile but remains supported by limited evidence. None should be used as a stand-alone basis to withhold or modify treatment. Full article

Background: Elderly and frail patients undergoing surgery for urological cancer have increased vulnerability to postoperative complications, delayed recovery, and functional decline. The da Vinci Single-Port (SP) platform may reduce surgical stress by enabling regionalized extraperitoneal, retroperitoneal, or transvesical access through a single incision. Objective: The objective was to provide a narrative review of the comparative evidence on da Vinci SP versus conventional multi-port (MP) robotic surgery in elderly or frail urological cancer patients. Methods: A structured search was performed to identify comparative studies reporting outcomes in patients defined as elderly by chronological age (≥65 years) or as frail by a validated frailty index. Findings are reported separately according to the vulnerability construct that was actually measured. Because of procedural and methodological heterogeneity, a narrative synthesis was performed, and the risk of bias was appraised qualitatively along the domains of the ROBINS-I tool. Results: Only three retrospective comparative studies are currently available: two on robot-assisted radical prostatectomy (one in patients aged ≥65 years and one in patients stratified by the 5-item modified frailty index) and one on robot-assisted partial nephrectomy in patients aged ≥65 years. Across these studies, SP surgery was associated with fewer early postoperative complications, shorter length of stay, and more favourable recovery-related endpoints, and in the frailty-stratified study the apparent protective effect increased with frailty burden. All estimates are those published by the original authors, are reported descriptively, and were not pooled. Importantly, in none of the three studies was the SP platform compared with MP surgery performed through the same access route: SP procedures were predominantly extraperitoneal or retroperitoneal and MP procedures were predominantly transperitoneal, so the effect of the platform cannot be separated from that of the access route. Conclusions: The available data are compatible with a reduction in early perioperative morbidity after SP robotic surgery in selected elderly or frail urological cancer patients, particularly when the platform enables extraperitoneal or retroperitoneal access. Because this evidence rests on three retrospective studies at serious risk of bias, the findings are preliminary and hypothesis-generating rather than confirmatory. Prospective studies incorporating geriatric screening, validated frailty metrics, patient-reported recovery, cost-effectiveness, and long-term oncological outcomes are needed. Full article

Radical cystectomy (RC) with urinary diversion (UD) is the standard treatment for muscle-invasive bladder cancer. Although the ileal conduit (IC) is the most commonly performed diversion, its reliance on bowel reconstruction leads to substantial perioperative morbidity and long-term complications. Cutaneous ureterostomy (CU) has re-emerged as an attractive alternative, particularly for elderly and medically frail patients, due to its technical simplicity and avoidance of intestinal manipulation. Recent single-stoma and tubeless modifications have aimed to overcome historical limitations of CU, including stomal stenosis and long-term stent dependence. Compared with IC, modern refinements of single-stoma CU showed shorter operative times and generally shorter hospital stays, largely reflecting avoidance of bowel reconstruction. Estimated blood loss and overall intraoperative complication rates were broadly comparable between diversion types. Contemporary retrospective data on single-stoma modifications showed lower rates of stomal stenosis and improved catheter-free outcomes compared with historical data, while infectious complications and readmission rates remained similar to those of IC in most series. Renal outcomes generally remained stable, with patient factors such as baseline renal function, hydronephrosis, and stent dependence appearing to be more influential for long-term deterioration than diversion type alone. Quality of life after contemporary single-stoma CU was similar to IC, based on the available retrospective evidence. Overall, contemporary single-stoma CU represents a valuable bowel-sparing urinary diversion that may potentially reduce operative burden while maintaining acceptable functional and quality-of-life outcomes. Current retrospective evidence supports its role as a particularly attractive option for elderly and frail patients, although prospective, multicenter comparative studies with standardized outcome reporting are still needed to better define patient selection and long-term outcomes. Full article

Background: Visceral obesity is increasingly recognised not as a simple excess of adipose tissue, but as a systemic pathological condition characterised by profound metabolic, endocrine, and immune dysregulation. Visceral adipose tissue (VAT) operates as an autonomous neuro-immune-endocrine organ whose dysfunctional expansion drives insulin resistance, atherogenesis, and accelerated cellular ageing through mechanisms converging on chronic low-grade sterile inflammation, referred to as inflammaging. Objectives: This narrative review integrates evidence across four domains: (1) the multi-system clinical complications of visceral obesity and the methodological controversies surrounding its measurement; (2) the cellular heterogeneity, immunometabolic reprogramming, and molecular mechanisms through which excess VAT accelerates biological ageing, with a focus on genomic instability, mitochondrial dysfunction, the NAD⁺/sirtuin regulatory axis, cellular senescence, and inter-organ communication; (3) the role of bioelectrical impedance analysis (BIA)—particularly phase angle—as a non-invasive functional biomarker of biological age and longevity, positioned critically against alternative assessment methods; and (4) current knowledge gaps and priorities for future research. Methods: A narrative review of PubMed/MEDLINE, Google Scholar, and the Cochrane Library was conducted using MeSH terms and free-text keywords including visceral obesity, bioelectrical impedance analysis, phase angle, sarcopenia, inflammaging, mitochondrial dysfunction, cellular senescence, epigenetic clocks, NAD⁺, sirtuin, and longevity, supplemented by citation-tracking of retrieved reviews. English-language articles published up to April 2025 were considered, prioritising systematic reviews, meta-analyses, and prospective cohort studies; formal risk-of-bias tools and quantitative synthesis were not applied, consistent with a narrative review design. Results and Discussion: BIA-derived phase angle constitutes a macroscopic electrobiological correlate of inflammaging: low phase angle values in visceral obese subjects overlap with those of frail elderly individuals, reflecting impaired membrane integrity, loss of active cell mass, and altered ICW/ECW balance. However, this evidence base remains largely cross-sectional and correlative; the directionality and population-specific calibration of BIA-derived indices constitute the principal unresolved methodological questions. Integration with epigenetic clocks, circulating NAD⁺ levels, and gut microbiome indices offers a framework for dynamic biological age assessment, though prospective interventional validation is still lacking. Sarcopenic obesity, evaluated through EWGSOP2 combined with BIA-derived skeletal muscle mass index and handgrip dynamometry, represents a critical comorbidity demanding integrated therapeutic targeting. Conclusions: BIA provides a quantitative, accessible correlate for translating cellular metabolic health into clinically actionable parameters, complementary to rather than a replacement for anthropometric and imaging-based methods. Optimising phase angle and reducing VAT through anti-inflammatory nutrition, exercise, and nutraceutical strategies targeting the NAD⁺/sirtuin and mTOR/AMPK axes constitutes a measurable objective for the promotion of healthy longevity, contingent on the longitudinal, mechanistic studies identified as priorities in this review. Full article

Elderly patients with heart failure (HF) represent a rapidly growing and highly heterogeneous population marked by multimorbidity, frailty, and polypharmacy. These age-related features profoundly influence the course of HF and modify therapeutic response. Vericiguat, a novel oral soluble guanylate cyclase (sGC) stimulator, targets the impaired nitric oxide (NO)-sGC-cyclic guanosine monophosphate (cGMP) pathway, a central mechanism in vascular dysfunction and maladaptive remodelling. Clinical evidence, primarily from the VICTORIA trial and subsequent studies, supports vericiguat in selected patients with heart failure with reduced ejection fraction (HFrEF), particularly following recent worsening HF despite guideline-directed medical therapy (GDMT). Most of the available evidence derives from HFrEF populations, whereas studies in heart failure with preserved ejection fraction (HFpEF) have not demonstrated significant clinical benefit. In addition, dedicated evidence in frail older adults and in patients with geriatric syndromes remains limited. This review summarises current knowledge on the pharmacological rationale, pharmacokinetics, and pivotal clinical studies of vericiguat, highlighting quantitative results and their implications for clinical implementation in elderly patients with HFrEF and complex clinical profiles. Full article

Health literacy (HL), recognized as a modifiable social determinant, influences the autonomy and clinical outcomes of the elderly population, so that low levels of HL contribute to worse health outcomes, including frailty. The objective was to analyze the factors associated with frailty, with a focus on HL, in elderly people from two municipalities in the interior of São Paulo. In this cross-sectional study of 219 elderly individuals (≥60 years) from Jundiaí and Araçatuba, frailty was measured using the FRAIL-BR scale and the Clinical-Functional Vulnerability Index (IVCF-20), and HL was measured using the 14-item Health Literacy Scale (HLS-14). Sociodemographic, clinical, and behavioral variables were included. Bivariate analyses and multinomial logistic regression were performed, with a significance level of 5%. Women predominated (64.8%), with an average age of 71.8 (±7.55). Low HL remained associated with frailty according to the FRAIL scale (OR = 3.66; 95% CI: 1.51–8.85) and the IVCF-20 (OR = 5.65; 95% CI: 1.83–17.44). Other factors common to both scales were advanced age (FRAIL: OR = 4.24; 95% CI: 1.26–14.28; IVCF-20: OR = 28.67; 95% CI: 5.31–154.89) and family dysfunction (FRAIL: OR = 3.67; 95% CI: 1.06–12.68; IVCF-20: OR = 6.81; 95% CI: 1.72–27.06). Living alone and diabetes were associated with the IVCF-20, while depression was associated with the FRAIL scale. This research constitutes the first empirical study conducted in Brazil to provide evidence that low levels of health literacy are significantly associated with frailty in older adults. Full article

Background/Objectives: Acute cholecystitis is a common surgical emergency associated with significant morbidity in elderly, frail, and critically ill poor surgical candidates. Early laparoscopic cholecystectomy remains the standard of care for low-risk patients, but interventional radiology (IR) modalities have been increasingly used in high-risk patients for gallbladder decompression, source control, and/or definitive non-operative treatment. Methods: A narrative review of the literature was performed to investigate current percutaneous IR options in acute cholecystitis. Evidence from international guidelines, randomized trials, systematic reviews, meta-analyses, and experimental novel techniques were reviewed. The patient selection approaches, timing of intervention, efficacy, complications, and risk of recurrence were summarized. Results: Percutaneous cholecystostomy remains the most commonly performed IR procedure for acute cholecystitis, offering decompression and source control in patients unfit for surgery. Percutaneous gallstone extraction and gallbladder chemical ablation, or cryoablation, have been used to reduce recurrence and long-term catheter dependence with promising results, but are still limited by complications and insufficient evidence. The variability in practice patterns and the absence of standardized treatment algorithms contribute to mixed results, ranging from long-term/definitive symptom control to the prolonged dependence on indwelling catheters and readmissions for catheter-related complications. Conclusions: IR plays an important role in the management of high-risk patients with acute cholecystitis. The careful selection of patients based on disease severity, physiologic reserve, frailty, and patient-centered goals is frequently limited by institutional resources. A structured clinical decision framework to guide IR-based interventions in acute cholecystitis is of the utmost importance to achieve optimal outcomes. Future studies should focus on standardized algorithms, patient-centered outcomes, recurrence, tube-free survival, and quality of life. Full article

Background: The number of older patients undergoing cardiac surgery is increasing, and a substantial proportion of these patients are frail. Frailty is associated with increased mortality, psychological complications, functional decline, and reduced health-related quality of life, complicating treatment decision-making. Currently, treatment recommendations are formulated by the multidisciplinary Heart Team and are mainly based on disease-related parameters. To better integrate patient preferences, geriatric assessment, and shared decision-making into routine cardiothoracic practice, a nurse-led preoperative outpatient pathway was developed: the Preoperative RIsk assessment and shared decision-Making in patients Eligible for cardiac surgery (PRIME) clinic. This study aims to evaluate whether the implementation of PRIME consultation influences Heart Team treatment recommendations and to assess its cost-effectiveness. Methods: This single-center, non-randomized prospective study is conducted in the Netherlands. Patients aged ≥70 years who are eligible for cardiac surgery and have two or more risk factors for adverse postoperative outcomes are included. All patients are initially discussed in the Heart Team, resulting in a treatment recommendation. Patients in the intervention group subsequently visit the PRIME clinic, where a comprehensive geriatric assessment and a shared decision-making consultation are performed. Following this visit, patients are re-evaluated by the Heart Team. The primary outcome is the comparison between the initial and subsequent Heart Team treatment recommendations. Secondary outcomes include health-related quality of life and cost-effectiveness. Discussion: This prospective exploratory study evaluates the implementation of a novel, patient-centered preoperative care model integrating geriatric assessment and shared decision-making into routine cardiac surgical practice. By focusing on outcomes meaningful to older patients and their relatives, the study contributes to the development of value-based, individualized surgical care. Trial registration: The PRIME study was registered in ClinicalTrials.gov (trial registration number: NCT06616129). Full article

Background: This review aims to provide a comprehensive and practical overview of the evolving role of autologous transplantation in leukaemias, a strategy that was once largely abandoned but has recently regained interest in selected clinical settings. Methods: We reviewed the historical development of autologous transplantation in acute leukaemias, including the early period during which autologous transplantation was considered inferior to allogeneic approaches because of limited graft purification techniques and the inability to induce effective graft-versus-leukaemia (GVL)-like immune responses. We further summarise more recent experimental strategies aimed at improving stem cell purification and enhancing anti-leukaemic immune activity in autologous settings. In addition, we discuss how advances in measurable residual disease (MRD) assessment and molecular risk stratification have contributed to the renewed interest in autologous transplantation in selected subgroups of leukaemia patients. Results: This review identifies clinical situations in which autologous transplantation remains an important therapeutic option, including plasma cell leukaemia, where it continues to represent a standard first-line approach. We also discuss well-defined patient subgroups, particularly selected AML subtypes with intermediate-risk molecular profiles and acute promyelocytic leukaemia (APL) in second remission, in which outcomes following autologous transplantation may be comparable to, or occasionally superior to, those achieved with allogeneic transplantation. In contrast, autologous transplantation currently plays only a limited role in diseases such as chronic lymphocytic leukaemia (CLL) and chronic myeloid leukaemia (CML). Although attempts to induce potent anti-leukaemic immune effects in autologous settings have so far shown limited clinical efficacy, several emerging strategies appear promising and may further expand the role of autologous transplantation, particularly in elderly or frail patients. Discussion: Overall, current molecular and MRD-based risk stratification strategies, together with emerging immunological and graft-manipulation approaches, may redefine the role of autologous transplantation as a personalised therapeutic option in selected subgroups of leukaemia patients. Full article

The coexistence of obesity, osteoporosis, and sarcopenia has been associated with adverse outcomes such as risk of falls, fractures, immobility, disability and frailty, yet data from Latin American populations are scarce. This study aimed to determine the prevalence and associations of obesity, osteoporosis, and sarcopenia—individually and combined—with frailty in Mexican elderly women. We conducted a cross-sectional study in which patients with body mass index < 18.5 kg/m², uncorrected sensory deficits, immobility, musculoskeletal diseases, or patients with implanted devices were excluded. Frailty was assessed using the FRAIL scale, obesity by body fat percentage, osteoporosis according to American Association of Clinical Endocrinology (AACE) guidelines and sarcopenia following the European Working Group on Sarcopenia in Older People-2 (EWGSOP2) recommendations. A total of 115 participants aged ≥60 years were assessed between January and June 2025. Frailty was present in 21.7% of the patients; 67.0% had obesity, 72.2% osteoporosis, 20.0% sarcopenia and 13.0% osteosarcopenic obesity. Sarcopenic phenotypes were associated with frailty: odds ratios (95% CI) were 3.05 (1.12–8.26) for sarcopenia, 4.23 (1.42–12.55) for sarcopenic obesity and 3.98 (1.28–12.40) for osteosarcopenic obesity. Sarcopenic phenotypes showed associations with frailty in Mexican elderly women. Full article

Background/Objectives: This study aims to evaluate the association between frailty syndrome and depressive symptoms within a cohort of patients with ischemic heart disease (IHD). Methods: This single-center cross-sectional study included 169 patients with IHD admitted for elective percutaneous coronary intervention. The median age was 68.00 [63.00–73.00] years; 59.7% of the patients were male. Frailty screening was performed using the European PRISMA-7 questionnaire, where a score of 3 or higher indicated a high probability of frailty. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15). The total GDS-15 score was interpreted as follows: 0–5 points indicated no depressive symptoms, 6–10 points indicated mild depression, and 11–15 points indicated severe depression. Results: The prevalence of frailty in the study cohort, based on the PRISMA-7 questionnaire, was 52.7%. The Geriatric Depression Scale (GDS-15) indicated a high probability of depressive symptoms in 19.5% of patients with IHD. The prevalence of depressive symptoms was significantly higher in frail than in non-frail patients. Furthermore, depressive disorders were 2.913 times more frequent among elderly frail patients with IHD compared to non-frail patients (95% CI: 1.262–6.725; p = 0.010). Correlation analysis confirmed a direct positive relationship between PRISMA-7 scores and GDS-15 scores (ρ = 0.392; p < 0.001). Conclusions: A significant association was identified between frailty and depressive symptoms in patients with IHD. Full article

Background/Objectives: Population ageing is accompanied by an increasing burden of multimorbidity and frailty, both of which are consistently associated with poorer health-related quality of life (QoL). Although several geriatric domains influence QoL in older adults, their combined association remain insufficiently explored in institutionalised populations. This study aimed to examine the independent and combined associations between age, multimorbidity, frailty, and QoL in institutionalised older adults and to explore which quality-of-life domain was most strongly associated with geriatric assessment variables. Methods: A cross-sectional study was conducted in 72 institutionalised older adults in Spain. Multimorbidity (number of chronic conditions), frailty (Fried phenotype), functional status, nutritional status, fall risk, and QoL were assessed using validated instruments, including the World Health Organization Quality of Life questionnaire. Pearson correlations and canonical correlation analysis were used to examine relationships between geriatric assessment variables and QoL domains. Analysis of variance and regression tree were subsequently applied to explore associations affecting the Physical Health domain. Results: A correlation analysis identified the Physical Health domain as the QoL dimension most strongly associated with geriatric variables. On the other hand, frailty, age and number of chronic diseases turned out to be the most explanatory in our study and were classified: the first according to the standard protocol, and the other two using a regression tree. Then, a three-way additive ANOVA explained 36.4% of the variance, with age as main influential. Namely, we estimate that the poorest QoL occurs in subjects over 84 who have more than three chronic conditions and are classified as frail. However, this is not a validated clinical decision rule since these cutoff points may vary in other samples. Conclusions: In this sample of institutionalised older adults, age emerged as the main variable associated with lower physical QoL, multimorbidity contributes to the cumulative burden of disease, and frailty may reflect the systemic decline in physiological reserves. Full article

Chronic respiratory diseases (CRDs) represent a significant global mortality burden, largely driven by viral-triggered exacerbations. In the elderly, susceptibility to viral pathogens is critically linked to the “interferon gap”—a kinetic delay in innate antiviral signaling resulting from immunosenescence and Th2-skewed inflammaging. While traditional vaccines provide pathogen-specific protection, their efficacy is often compromised by age-related immune hyporesponsiveness and antigenic drift. This perspective paper proposes a dual-phase, virus-agnostic immunomodulatory platform designed to restore mucosal immune competence and provide a rapid-response intervention for incipient exacerbations. Rather than acting as a pathogen-specific vaccine, the platform serves as a comprehensive host immune-rejuvenation engine and cellular adjuvant platform. The platform consists of two integrated stages: Allopriming and Alloantigen Inhalation Recall (AIR). Allopriming utilizes AlloStim^® (activated, allogeneic Th1 cells) to leverage the evolutionarily conserved allo-rejection response, establishing a lung mucosal reservoir of allo-specific Th1 tissue-resident memory cells (Trm). Building on previously published Phase I/II data showing that Allopriming reverses biomarkers of immunosenescence and sustains durable heterologous antiviral responsiveness, the AIR strategy is introduced as a patient-administered rescue mechanism for frail CRD patients. AIR is designed to activate pre-positioned Trm cells at the earliest onset of symptoms, inducing a high-magnitude IFN-γ surge in the lung mucosa. By bridging the senescent “interferon gap” with the rapid effector kinetics of Trm activation, this approach represents a novel paradigm toward reconstituting youthful-like antiviral mucosal immunity to both enhance vaccine efficacy in the elderly and protect against both seasonal pathogens and emerging viral triggers (“Disease X”) of CRD. Future randomized studies in long-term care settings are planned to evaluate clinical outcomes in high-risk populations. Full article

The rapid evolution of structural heart interventions, particularly transcatheter aortic valve implantation (TAVI), transcatheter edge-to-edge repair (TEER), and hybrid procedures, has significantly expanded treatment options for elderly, frail, and multimorbid patients previously considered high risk or inoperable. However, perioperative risk stratification in this population remains challenging. Traditional risk scores such as EuroSCORE, EuroSCORE II, STS-PROM, CHA₂DS₂-VASc, and HAS-BLED were developed and validated primarily in cohorts undergoing conventional open-heart surgery (CABG and surgical valve replacement) more than 15–25 years ago. This narrative review critically evaluates the performance and limitations of these classical models in contemporary populations undergoing modern structural cardiac interventions. Evidence from registries and meta-analyses indicates only moderate discriminatory ability and systematic calibration errors. EuroSCORE II and STS-PROM frequently overestimate risk in low- and intermediate-risk patients while underestimating it in high-risk and frail individuals, particularly regarding neurological, renal complications, and prolonged hospitalization. Similar limitations apply to CHA₂DS₂-VASc and HAS-BLED when used beyond their original scope in the peri-procedural setting of TAVI/TEER. The review highlights the growing role of frailty assessment, procedure-specific variables, and machine learning algorithms, which demonstrate superior predictive performance compared to conventional scores. Until dedicated, regularly updated risk models based on large TAVI/TEER registries become available, traditional scores should be used only as supportive tools within multidisciplinary Heart Team discussions that incorporate individual frailty, quality of life, and patient preferences. Full article